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C&e Hiorarp 

Of tJ)f 

Dit)t0ion of l£>ealt& affairs 
CJntoersitp of Ji3ottfj Carolina 




This Book Must Not Be Taken 
from the Division of Health 

Affairs Buildings. 

FOUR DAYS c 

This JOURNAL may be kept ouUTWO DAYS, 
and is subject to a fine of FIVE fc&IVr*S*day 
thereafter. It is DUE on the DAY indicated 
below: 




NORTH CAROLINA MEDICAL JOURNAL 

Owned and Published by 

THE MEDICAL SOCIETY OF THE STATE OF NORTH CAROLINA 

Under the Direction of Its 



EDITORIAL BOARD 



Wingate M. Johnson, M.D. 

Winston-Salem, Editor 

Mr. James T. Barnes 

Raleigh, Business Manager 

G. Westbrook Murphy, M.D. 

Asheville, Chairman 

Ernest W. Furgurson, M.D. 

Plymouth 



John Borden Graham, M.D. 

Chapel Hill 

William M. Nicholson, M.D. 

Durham 

Robert W. Prichard, M.D. 

Winston-Salem 

Charles W. Styron, M.D. 

Raleigh 



Miss Louise MacMillan 

Winston-Salem, Assistant Editor 



VOLUME 21 



JANUARY-DECEMBER, 1960 



300 South Hawthorne Road 



EDITORIAL OFFICE 



Winston-Salem 7, N. C. 



Press of 

CARMICHAEL PRINTING COMPANY 



1309 Hawthorne Road, SW 



Winston-Salem, N. C. 



-T 






Digitized by the Internet Archive 

in 2011 with funding from 

North Carolina History of Health Digital Collection, an LSTA-funded NC ECHO digitization grant project 



http://www.archive.org/details/ncarolinamed2121960medi 



NORTH CAROLINA 







IN THIS ISSUE: 

THE PRESIDENT'S INAUGURAL ADDRESS 
— AMOS N. JOHNSON, M.D. — 



N£ 3 






Surfadil 

thycaine and thenylpyramir.e, Lilly) 

SHIELDS 

SENSITIVE 

SKIN 



Each 100 cc. of Lotion Surfadil provide: 

local 
antihistamine . . Histadyl* ... 2 Gm. 

topical anesthetic . Surfacaine* . . 0.5 Gm. 

adsorptive and 

protective cover Titanium Dioxide . 5 Gm. 

The Surfadil coating also acts as a translucent 
"shield" to deflect the sun's rays. 

Available in spillproof. unbreakable plastic 
containers of 75 cc. and in pint bottles. 



Hisladyl® (thenylpyramine. Lilly) 
Surfacatne® (cyclomethycaine, Lilly) 



ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U. S. A. 



STm, 







Table of Contents, Page II 



CLINICAL REMISSION 

IN A "PROBLEM" ARTHRITIC 

In "escaping" rheumatoid arthritis . After gradually "escaping" the ther- 
apeutic effects of other steroids, a 52-year-old accountant with ar- 
thritis for five years was started on Decadron. 1 mg. /day. Ten months 
later, still on the same dosage of Decadron, weight remains constant, 
she has lost no time from work, and has had no untoward effects. She 
is in clinical remission .* 

New convenient b. i. d. alternate dosage schedule: the degree and extent of relief provided by 
DECADRON allows for b.i.d. maintenance dosage in many patients with so-called "chronic" condi- 
tions. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule. 

Supplied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available 
as Injection DECADRON Phosphate. Additional information on DECADRON is available to physicians 
on request. DECADRON is a trademark of Merck & Co.. inc. 

'From a clinical investigator's report to Merck Sharp & Dohme. 



Decadron 




Dexamethasone 



TREATS MORE PATIENTS MORE EFFECTIVELY 

&3m MERCK SHARP & DOHME • Division of Merck & Co., Inc., West Point, Pa. 




■ ,. 



•f.* 



/ 



.T= 






SK- 




A\ 




l n 










f$ii£ 



July, 1960 



ADVERTISEMENTS 




A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous 
and Mental Diseases, Alcoholism and Drug Addiction. 

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park 
of long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern 
Pines. This section is unexcelled for its healthful climate. 

Ample facilities are afforded for recreational and occupational therapy, particularly out- 
of-doors. 

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at 
an understanding of his problems and by adjustment to his personality difficulties or 
modification of personality traits to effect a cure or improvement in the disease. Two resident 
physicians and a limited number of patients afford individual treatment in each case. 

For further information write: 

The Pineblu££ Sanitarium, Pinebluff, N. c. 



Malcolm D. Kemp, M.D. 



Medical Director 



WELCH ALLYN RECTAL SETS 

Welch Allyn distally illuminated proctoscopes 
and sigmoidoscopes are designed to meet every 
requirement for thorough rectal examination 
and treatment. Abundant illumination is pro- 
vided directly at the area under observation and 
an unobstructed view for diagnosis is assured 
through the use of a small, powerful Welch 
Allyn "Bright Light" lamp. The outer tube is 
calibrated in centimeters and the inner tube is 
optically designed to reduce the annoying glare 
usually found in this type instrument. The 
obturator tip is tapered and curved in an an- 
atomically correct manner to facilitate the 
passage of the instrument through the sphincter 
muscle and by the prostate gland region. Ideally 
designed for use with No. 343 biopsy punch. 

No. 314 No. 300 proctoscope and No. 308 sigmoidoscope with inflating bulb and No. 725 cord, 
in case as illustrated $73.50 

No. 343 BIOPSY PUNCH not illustrated S66.00 




WINCHESTER 

"CAROLINAS' HOUSE OF SERVICE" 



WINCHESTER SURGIICAL SUPPLY CO. 
119 East 7th Street Charlotte, N. C. 



WINCHESTER-RITCH SURGICAL CO. 

421 West Smith St. Greensboro, N. C. 



II 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



North Carolina Medical Journal 

Official Organ of 
The Medical Society of the State of North Carolina 



Volume 21 
Number 7 



JULY, 1960 



76 CENTS A COPY 
$5.00 A YEAR 



CONTENT 



Original Articles 



President's Inaugural 
Johnson, M.D. . . 



Address — Amos N. 



261 



Bad Politics and Good Medicine Don't Mix- 
Louis M Orr, M.D 



264 



Three Great Challenges — Leonard W. Larson, 
M.D 267 

Generalized Salivary Gland Virus Disease in 
Postneonatal Life — Charles F. Gilbert, 
M.D 270 

Antibiotic Resistant Pulmonary Staphylococ- 
cic Infections— George L. Calvy, MC, USN 275 

Some Facts About Nursing in North Carolina 
—Vivian M. Culver 279 



A Rural Home Care Program — C. David Gar- 
vin, M.D., M.P.H 282 

Report on Actions of the House of Delegates, 
American Medical Association, One Hun- 
dredth Ninth Annual Meeting — F. J. L. 
Blasingham, M.D 285 



CORRESPONDENCE 

Biennial Registration Act — J. R. Gamble, Jr., 
M.D 

COMMITTEES AND ORGANIZATIONS 

Schedule of Committee and Commission Ap- 
pointments, 1960-1961 



292 



293 



Bulletin Board 

Coming Meetings 

News Notes from the Duke University Med- 
ical Center 

News Notes from the University of North 
Carolina School of Medicine 

News Notes from the Bowman Gray School 
of Medicine of Wake Forest College . . . 

County Societies 

News Notes 

Announcements 

The Month in Washington 

308 



300 
301 
302 



303 
304 
304 

305 



Editorials 

The A.M.A.'s One Hundred Ninth Annual 

Meeting 289 

The Old Order Changeth 289 

"Symptomatic Medicine" 290 

Nurses and Nursing 291 

Medical Prepayment and Our Social Philo- 
sophy 291 



Book Reviews 

309 

In Memoriam 

312 

Classified Advertisements 

308 

Index to Advertisers 
lxiii 



Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of 
August 24, 1912. Copyright 1960 by the Medical Society of the State of North Carolina. 







17 



-202 



tL ' cka -l Letter SpinTEi^IT 
« Shown Below 






rolin 



idics" 



>F CHLORAL HYDRATE 



"kry will di«. 
"dtbi, column 



T, '\ -Dec, 

I960 



11 



WoodeD 



4838 



able chloral hydrate syrup 



containing 10 grains in each teaspoonful. 



JONES and VAUGHAN 
Richmond 26, Virginia 



■ 



■ ■■■*'■ 



A most appetizing help for 
patients where a cholesterol 
depressant diet is prescribed 



Wesson's Chicken Cook Book 

FREE in quantities 

for your distribution to patients 






Wesson 


.. 




for Frying 
^kirtg and Sala* 


Iftfe 




UTm] 





The enticing variety of dishes offered in "101 Glorious Ways to 
Cook Chicken" can help make a restricted regimen less monotonous 
and encourages the patient's compliance with it. 

The high poly-unsaturated fat content of poultry— prepared in 
poly-unsaturated Wesson — makes it a special help to those on 
cholesterol depressant diets. Happily, too, chicken is moderate in 
calories, universally popular and one of the most economical 
protein foods in the grocery today. 

Recipes for Chicken Rosemary, Sesame, Jambalaya, Pilaf, etc., 
teach scores of new ways to enhance chicken with herbs and 
spices, new combinations with fruits and vegetables, how to use 
sauces and seasonings wisely and well. Careful consideration has 
been given to the choice of ingredients to keep saturated fats 
to a minimum. 

Where a vegetable (salad) oil is medically 

recommended for a cholesterol depressant regimen, 
Wesson is unsurpassed by any readily available brand. 



1^% jf& 




HICKEN SESAME — with its crunchy nutlike flavor from the Indies — is typical of the glorious eating contained in this new Wesson cook book. 



WESSON'S IMPORTANT CONSTITUENTS 

Wesson is 100% cottonseed oil . . . 
winterized and of selected quality 

inoleic acid glycendes (poly-unsaturated) 50-55 % 

Jleic acid glycerides (mono-unsaturated) 16-20% 

otal unsaturated 70-75% 

'almitic, stearic and myristic glycerides (saturated) 25-30% 

'hytosterol (predominantly beta sitosterol) 0.3-0.5% 

Total tocopherols 0.09-0.12% 

Never hydrogenated— completely salt free 

Each pint of Wesson contains 437-524 Int. Units of Vitamin E 



Send coupon for quantity needed for your patients. 

The Wesson People, 210 Baronne Street, 
New Orleans 12, La. 

Please send me . . . free copies of the Wesson cook book 
"101 Glorious Ways to Cook Chicken." 



Name. . 
Address 
City.... 



.Zone. 



.State. 



VI NORTH CAROLINA MEDICAL JOURNAL July. 1960 



Proven 

in over five years of clinical use and 
more than 750 published clinical studies 

Effective 

for relief of anxiety and tension 

Outstandingly Safe 

• simple dosage schedule produces rapid, reliable 
tranquilization without unpredictable excitation 

• no cumulative effects, thus no need for difficult 
dosage readjustments 

• does not produce ataxia, change in appetite or libido 

• does not produce depression, Parkinson-like symptoms, 
jaundice or agranulocytosis 

• does not impair mental efficiency or normal behavior 



for 
the 

tense 
and 
nervous 
patient 




Despite the introduction in recent years of "new and dif- 
ferent" tranquilizers, Miltown continues, quietly and 
steadfastly, to gain in acceptance. Generically and under 
the various brand names by which it is distributed, 
meprobamate ( Miltown I is prescribed by the medical 
profession more than any other tranquilizer in the world. 

The reasons are not hard to find. Miltown is a known drug, 
evaluated in more than 750 published clinical reports. Its 
few side effects have been fully reported; there are no 
surprises in store for either the patient or the physician. 
It can be relied upon to calm anxiety and tension quickly 
and predictably. 



Usual dosage : One or two 
400 mg. tablets t.i.d. 
Supplied: 400 mg. scored tablets, 
200 mg. sugar-coated tablets; 
or as meprotabs*-400 mg. 
unmarked, coated tablets. 



Miltown 



meprobamate (Wallace) 



' WALLACE LABORATORIES / New Brunsivick, N. J. 
V*" 



July, 1960 ADVERTISEMENTS VII 




when that early Monday morning telephone 
call is from a weekend do-it-yourselfer 

". . . and this morning, Doctor, my back 
is so stiff and sore I can hardly move." 

now. . . there is a way to prompt, dependable 
relief of back distress 

the pain goes while the muscle relaxes 



POTENT —rapid relief in acute conditions 
SAFE — for prolonged use in chronic conditions 

notable safety — extremely low toxicity; no known 
contraindications; side effects are rare; 
drowsiness may occur, usually at higher dosages 

rapid action, sustained effect —starts to act 
quickly, relief lasts up to 6 hours 

easy to use — usual adult dosage is one 350 mg. 
tablet 3 times daily and at bedtime 

supplied -as 350 mg., white, coated tablets, 
bottles of 50; also available for pediatric use: 
250 mg., orange capsules, bottles of 50 

V A y WALLACE LABORATORIES, New Brunswick, New Jersey 




(CARISOPRODOL WALLACE) 



VIII NORTH CAROLINA MEDICAL JOURNAL July, 1960 

Medical Society of the State of North Carolina 

OFFICERS — 1960 

President — Amos Neill Johnson, M.D., Garland 

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte 
Past. President — John C. Reece, M.D., Grace Hospital, Morganton 
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville 
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest 
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh 
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh 
The President, Secretary and Executive Director are members ex-officio 

of all committees 
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington 
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville 



COUNCILORS — 1958 - 1961 

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford 

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro 
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston 

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington 
Third District — Dewey H. Bridger, M.D., Bladenboro 

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville 
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg 

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton 
Fifth District — Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet 

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst 
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh 

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford 

Seventh District — 

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle 

Eighth District — Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro 

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin 
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury 

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville 
Tenth District — William A. Sams, M.D., Main Street, Marshall 

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill 

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION 

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte 

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro 

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh 

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst 

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville p 

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham 

m 

SECTION CHAIRMEN 1959-1960 cl 

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard 
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City 
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott 

Avenue, Charlotte 
Surgery — JAMES E. DAVIS. M.D., 1200 Broad Street, Durham 
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh 
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston 
Public Health and Education — ISA C. Grant, M.D., Box 949, Raleigh 
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital, 

Chapel Hill 
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine, 

Winston-Salem 
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville 
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown 
Orthopedics & Traumatology — CHALMERS R. CARR, M.D., 1822 Brunswick Avenue 

Charlotte 
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine, 

Durham 



PAPAIN 

IS THE 

KEY 

to complete, thorough 
vaginal cleansing 




mucolytic, acidifying, 
physiologic vaginal douche 



The papain content of Meta Cine is the key 
reason why it effects such complete cleansing of 
the vaginal vault. Papain is a natural digestant, 
and is capable of rendering soluble from 200- 
300 times its weight of coagulated egg albumin. 
In the vagina, papain serves to dissolve mucus 
plugs and coagulum. 

Meta Cine also contains lactose — to promote 
growth of desirable Doderlein bacilli — and 
methyl salicylate, eucalyptol, menthol and 
chlorothymol, to stimulate both circulation and 
normal protective vaginal secretions. Meta 
Cine's pleasant, deodorizing, non-medicinal fra- 
grance will meet your patients' esthetic demands. 

Supplied in 4 oz. and 8 oz. containers, and in 
boxes of 30 individual-dose packets. Dosage: 
2 teaspoonfuls, or contents of 1 packet, in 2 
quarts of warm water. 




lb 

HKAYTIN 



BRAYTEN PHARMACEUTICAL COMPANY Chattanooga 9, Tennessee 






When summertime 
chores bring on 

LOW BACK PAIN 



Brand of chlormezanone 

relaxes skeletal 

muscle spasm - 

ends disability. 




How Supplied: Trancopal Caplets® 

200 mg. (green colored, scored), bottles of 100. 
100 rag. (peach colored, scored) , bottles of 100. 

Dosage: Adults, 200 or 100 mg. orally three or four 
times daily. Relief of symptoms occurs in from 
fifteen to thirty minutes and lasts from four to six 
hours. 

References: 1. Lichtman, A. L.: Kentucky Acad. Gen. 
Pract. J. 4:28, Oct., 1958. 2. Lichtman, A. L.: Scientific 
Exhibit, Internat. Coll. Surgeons, Miami Beach, Fla., Jan. 
4-7, 1959. 3. Gruenberg, Friedrich: Current Therap. Res. 
2:1, Jan., 1960. 4. Kearney, R. D.: Current Therap. Res. 
2:127, April. 1960. 



LABORATORIES 
New York 18, N.Y. 



hen any of a host of summer activities brings on low back pain 
associated with skeletal muscle spasm, your patient need not be dis- 
abled or even uncomfortable. The spasm can be relaxed with 
Trancopal, and relief of pain and disability will follow promptly. 

Lichtman 1,2 used Trancopal to treat patients with low back pain, 
stiff neck, bursitis, rheumatoid arthritis, osteoarthritis, trauma, and 
postoperative muscle spasm. He noted that Trancopal produced 
satisfactory relief in 817 of 879 patients (excellent results in 268, 
good in 448 and fair in 101). 

Gruenberg 3 prescribed Trancopal for 70 patients with low back 
pain and observed that it brought marked improvement to all. "In 
addition to relieving spasm and pain, with subsequent improvement 
in movement and function, Trancopal reduced restlessness and 
irritability in a number of patients." 3 In another series, Kearney 4 
reported that Trancopal produced relief in 181 of 193 patients 
suffering from low back pain and other forms of musculoskeletal 
spasm. 

Trancopal enables the anxious patient to work or play . According 
to Gruenberg, "In addition to relieving muscle spasm in a variety 
of musculoskeletal and neurologic conditions, Trancopal also exerts 
a marked tranquilizing action in anxiety and tension states." 3 
Kearney 4 found ". . . that Trancopal is the most effective oral skeletal 
muscle relaxant and mild tranquilizer currently available." 

Side effects are rare and mild. "Trancopal is exceptionally safe for 
clinical use." 3 In the 70 patients with low back pain treated by 
Gruenberg, 3 the only side effect noted was mild nausea which oc- 
curred in 2 patients. In Lichtman's group, "No patient discontinued 
chlormethazanone [Trancopal] because of intolerance." 1 



July, 1960 



ADVERTISEMENTS 



XI 



ALL OVER AMERICA! 

KENTwiththe MICRONITE FILTER 

IS SMOKED BY 
MORE SCIENTISTS and EDUCATORS 

than an y other ci g arette !* 



FIVE TOP BRANDS 


OF 


CIGARETTES 




SMOKED BY AMERICAN 


SCIENTISTS 










15.3% 








10.5% 
7.9% 


BRAND -F- m— 1 






7.6% 


BRAND "B -"»■—'"■■' 






7.3% 


■■K 




FIVE TOP BRANDS OF CIGARETTES 
SMOKED BY AMERICAN EDUCATORS 

BRAND "G" m il il l M l 

BRAND "E" 
BRAND ~A" 
BRAND "F" 



THIS does not constitute a 
professional endorsement 
of Kent. But these men, like 
millions of other Kent smokers, 
smoke for pleasure, and choose 
their cigarette accordingly. 




The rich pleasure of smoking 
Kent comes from the flavor 
of the world's finest natural 
tobaccos, and the free and 
easy draw of Kent's famous 
Micronite Filter. 



If you would like the booklet, "The Story of Kent", for your 
own use, write to: P. Lorillard Company — Research De- 
partment, 200 East 42nd Street, New York 17, New York. 




INO-1IZI, 
REOULAI 1UJ 
01 CRUIH-FIOOF 10ft 



For good smoking taste, WM 1S1¥ 

it makes good sense to smoke IBLIU [Hill 



jf. Results ot a continuing study of cigarette preferences, conducted by 0'Bnen Sherwood Associates, NT., NY. 
A PRODUCT OF P LORILLARD COMPANY FIRST WITH THE FINEST CIGARETTES THROUGH LORILLARD RESEARCH 



O ':.,' ..^A'jia 



" 



life 
/saving 

in / many cases . . 




-V 





NJECTION 



...a highly potent, 
bactericidal antibiotic 
for combating staph and 
gram negative infections 



Kanamycin Sulfate Injectton 



. . .well tolerated when 
used on a properly individ- 
ualized dosage schedule 
which does not induce 
excessive blood levels 



"In many instances its effect has been dramatic and life saving . . ."* 

"Six of the patients who survived were considered to be terminally ill at the time 
kanamycin was started but showed dramatic improvement and eventual complete 
recovery 



»2 



". . . indeed, the results [with kanamycin] are the most remarkable ever achieved 
with otherwise fatal staphylococcal infections that we have ever seen." 3 

"There appears to be no doubt that kanamycin has been lifesaving in those in- 
stances in which organismal resistance precludes the use of other antimicrobials." 4 

Information on dosage, administration and 'precautions 
contained in package insert or available on request. 

SUPPLY: Kantrex Injection, 0.5 Gm. kanamycin (as sulfate) in vial containing 2 ml. volume. 
Kantrex Injection, 1.0 Gm. kanamycin (as sulfate) in vial containing 3 ml. volume. 

REFERENCES: 1. Yow, E. M.: Practitioner 182:759, 1959. 2. Yow, M. D., and Womack, G. K.: Ann. N. Y. Acad. Sci. 76:363, 
1958. 3. Bunn, P. A., Baltch, A., and Krajnyak, 0.: Ibid. 76:109, 1958. 4. Council on Drugs, J.A.M.A. 172:699, 1960. 



BRISTOL LABORATORIES, SYRACUSE, NEW YORK 






7 



Vhen STRESS accompanies secondary anemias 



IBIlIWi 


gtjgfc 


us Fumarate 


ISO mg 


180 mg. Fe 




in B-12 with Intrinsic Fictor 
ntrate, Non-Inhibitory 


1/9 USF 
Oral Uni 


1/3 USP 
t Oral Unit 
(6 meg. B-12) 


4 meg B-12 


bic Acid 


100 mg 


300 mg. 


300 mg. 


Tine Mononitrate (B-l) 


3 3 mn 


10 mg. 


10 mg. 


avin (B-2> 


T '■ mg 


10 mg. 


10 mg. 


oxine Hydrochloride (B-6) 


0.67 mg 


2 mg. 


2.0 mg. 


namide 


33.3 mg 


100 mg. 


100 mg. 


jm Pantohenate 


6.67 mg 


20 mg. 


20 mg. 


Acid 


0.5 mg 


1.5 mg. 


1.5 mg. 


w (From Copper Sulfate) 


3.0 mg 


9.0 mg. 




anese (From Mn Sulfate) 


3.0 mg 


9.0 mgr. 




t (From Cobalt Sulfate! 


0.05 mg 


0.15 mg. 




(From Zinc Sulfate) 


0.3 mg 


0.9 mg. 





This unique comprehensive formula provides a broad new concept in the treatment 
of anemias, in convalescence, and in the prevention and treatment of nutritioi 
deficiencies. As indicated by its formula, dosage control is more easily maintains 
with HEMOTREXIN. All treatable secondary' anemias, especially when aceonv 
panied by stress conditions, as in anemias of pregnancy, convalescence, adolescence 
post-infection anemias, anemias following drug therapy, and in the prevention am 
treatment of nutritional deficiencies . . . respond favorably to HEMOTREXIN. 



DOSAGE 

Adults: one tablet three times daily after 

meals. 
Children: one to three tablets according to 
age. 



"r?nrpr7JT7r7orPT7 nr?/^7 



SAMPLES AND 
LITERATURE 
GLADLY SENT 
UPON REQUEST. 



Raise the Pain Threshold 





Phenaphen with Codeine provides 

intensified codeine effects with 

control of adverse reactions. 

It renders unnecessary (or postpones) 

the use of morphine or addicting 

synthetic narcotics, even in 

many cases of late cancer.. 




Three Strengths — 

PHENAPHEN NO. 2 

Phenaphen with Codeine Phosphate Vt gr. (16.2 mg.) 

PHENAPHEN NO. 3 

Phenaphen with Codeine Phosphate Vi gr. (32.4 mg.) 

PHENAPHEN NO. 4 

Phenaphen with Codeine Phosphate 1 gr. (64.8 mg.) 

Aho- 

PHENAPHEN In each cap.ule 

Acetylsalicylic Acid 2% gr. . (162 mg.) 

Phenacetin 3 gr (194 mg.) 

Phenobarbital % gr. (16.2 mg.) 

Hyoscyamine sulfate (0.031 mg.) 




PHENAPHEN with CODEINEh 



Rgbins | 



A. H. ROBINS CO.. INC., RICHMOND 20. VIRGINIA 
Ethical Pharmaceuticals of Merit since 1878 



• • 






— % 






}■ 



s*~e 




-A » •. •. ;. • -:::*■■* r \'h \ •■:-'..• /*s*V 

* • **" ••..•;:: •-•.' M ' i '•".:. .••' •.•-•-„••••' "••.*«.« •*. • 

.•, ■•:'•!... ...„..:*.•;..-.••- •'.-?..:* : ... ■„■>.■ ',-. .;. ' : • *■>- • •• •. . 

:•.••■•*• '. .:• * .•:."/... ■•'.' •'•• : •••'••' •• V *' .'.••'5/-. r; . : - ."• *- ; • 

■•..•/.•.". •'.•..;•. '.*• ■'■:■'• :••'•■ \V . ^.Vi- »V. ; . , / A-S .•''•''£".• .*,.' - 

• ••'.•* .•*. .• V'i'v :'•;'.•'■ •'.'••'.:•;*• .' ^\".1'°- •.•.'.'•"/"/.•—•I- <".'•..■• ..7- ' •'•*/ *. • ■**• 

■•'. ...••:■•.'• •••■v.-.:..-." -'•'• -v-v* •*.- •'•• •' -.•''•••••:• • ■ •-.-. "• .'-.♦• 
:••• .•••;v//-.Vv-'sV-.". '•.;;» v •*.. ...•••/•:;;•••. •• "•>:-:.•;.-' 

■-.'••"i: ::■/.'• '.••••' r -'.." './•>'• ;'..•;•: .•*/•.-.•/ :: •. •: -v. -.*• ■;•/.' -.•..•/ ' 
."■•'' . •'.-■ • ■ .•* '■• .'•.'''..•'"'■•• '.•■■• ' *♦.»•' . 

Triaminic 

...relief from pollen allergies 

more complete than antihistamines alone... more thorough than nose drops or sprays 

The miseries of respiratory allergy can be relieved so effectively 
with Triaminic. 15 Triaminic contains two antihistamines plus 
the decongestant, phenylpropanolamine, to help shrink the en- 
gorged capillaries, reduce congestion and bring relief from rhin- 
orrhea and sinusitis. 1 Oral administration distributes medication 
to all respiratory membranes without risk of "nose drop addic- 
tion" or rebound congestion.- 3 

Each Triaminic timed-release Tablet provides: 

Phenylpropanolamine HCI 50 mg. 

Pheniramine maleate 25 mg. 

Pyrilamine maleate 25 mg. 

also available: 

TRIAMINIC JUVELETS S Vi the formulation of the Triaminic Tablet with timed-release action. 

TRIAMINIC SYRUP each teaspoonful (5 ml.) provides Va the formulation of the Triaminic Tablet. 

References: 1. Fabrlcant, N. D.: E. E. N.T. Monthly 37:460 (July) 1958. 2. Lhotka. F. M.: Illinois M.J. 112 259 
(Dec ) 1957. 3. Farmer, D. F.: Clin. Med. 5:1183 (Sept.) 1958. 4. Fuchs, M.; Bodi.T.: Mallen, S. R.; Hernando. L, 
and Moyer, J.H.: Antibiotic Med. &. Clin. Ther. 7:37 (Jan) 1960. 5. Halpern, S. R.. and Rabinowitz, H.: Ann. 
Allergy 18:36 (Jan.) 1960. 

«4jfl ^^ . first— the outer layer dissolves 
jr^i "^^^^ within minutes to produce 

Relief Is prompt and prolonged jj \^^^\ J 3 to 4 hours of relief 

because of this special BP JL /" x 

Pl^fc^^j^^ ^ then — the core disintegrates 

timed-release action \§j/p ^^T~^™B t0 give 3 10 4 mcre 



S ????? ? 8 



* * S i 8 * * 



* ? 2 S ? 



' s 
i 
s 



GONORRHEA IS ON THE MARCH AGAIN... 



a new timetable for recovery: 

only six capsules of TETREX can cure a male patient with gonorrhea in just one day 4 



Tet 



® 




U.S. PAT. NO. 2. 791,609 

THE ORIGINAL TETRACYCLINE PHOSPHATE COMPLEX 



TETREX CAPSULES. 250 mg. Each capsule contains: 
TETREX (tetracycline phosphate complex equivalent to 
tetracycline HCI activity) - 250 mg. 
DOSAGE: Gonorrhea in the male -Six capsules of 
TETREX in 3 divided doses, in one day. 

v Marmell, M., and Prigot, A.: Tetracycline phosphate complex in the treat- 
ment of acute qonococcal urethritis in men. Antibiotic Med. & Clin. Ther. 
6:108 (Feb) 1959. 



BRISTOL LABORATORIES, 

SYRACUSE, NEW YORK 





THE 

REALMS 

OF THERAPY 




| fBASSPDRT 
TO, - 
TRANQUILH*Y 



ATTAINED 
WITH 




ATA RAX 



(brand of hydroxyzine) 



V World-wide record of effectiveness-over 200 labora- 
tory and clinical papers from 14 countries. 
Widest latitude of safety and flexibility-no serious 
adverse clinical reaction ever documented. 
Chemically distinct among tranquilizers— not a pheno- 
thiazine or a meprobamate. 
Added frontiers of usefulness— antihistamine; mildly 
antiarrhythmic; does not stimulate gastric secretion. 



Special Advantages 




unusually safe; tasty syrup, 
10 mg. tablet 






well tolerated by debilitated 
patients 




useful adjunctive therapy for 
asthma and dermatosis; par- 
ticularly effective in urticaria 



W IN 

i HYPEREMOTIVE § 

does not impair mental acuity 



Supportive Clinical Observation 

". . . Atarax appeared to reduce anxiety 
and restlessness, improve sleep pat- 
terns and make the child more amen- 
able to the development of new pat- 
terns of behavior. . . ." Freedman, A. 
M. : Pediat. Clin. North America 5:573 
(Aug.) 1958. 



". . . seems to be the agent of choice 
in patients suffering from removal dis- 
orientation, confusion, conversion hys- 
teria and other psychoneurotic condi- 
tions occurring in old age." Smigel, 
J. 0., et al.: J. Am. Geriatrics Soc. 
7:61 (Jan.) 1959. 



"All [asthmatic] patients reported 
greater calmness and were able to 
rest and sleep better... and led a 
more normal life. ... In chronic and 
acute urticaria, however, hydroxyzine 
was effective as the sole medica- 
ment." Santos, I. M., and Unger, L: 
Presented at 14th Annual Congress, 
American College of Allergists, Atlan- 
tic City, New Jersey, April 23-25, 1958. 



L 




". . . especially well-suited for ambula- 
tory neurotics who must work, drive 
a car, or operate machinery." Ayd, F. 
J., Jr.: New York J. Med. 57:1742 (May 
15) 1957. 



New York 17, N.Y. 

Division, Chas. Pfizer & Co., Inc. 

Science for the World's Weil-Being 



.and for additional evidence 



Bayart, J.: Acta paediat. belg. 
10:164, 1956. Ayd, F. J., Jr.: Cal- 
ifornia Med. 87:75 (Aug.) 1957. 
Nathan, L. A., and Andelman, M. 
B.: Illinois M. J. 112:171 (Oct.) 
1957. 



Settel, E.: Am. Pract. & Digest 
Treat. 8:1584 (Oct.) 1957. Negri, 
F.: Minerva med. 48:607 (Feb. 
21) 1957. Shalowitz, M.: Geri- 
atrics 11:312 (July) 1956. 



Eisenberg, B. C: J.A.M.A. 169:14 
(Jan. 3) 1959. Coirault, R„ et al.: 
Presse mki. 64:2239 (Dec. 26) 
1956. Robinson, H. M.. Jr., et al.: 
South. M. J. 50:1282 (Oct.) 1957. 



^^ 



Garber, R. C, Jr.: J. Florida M. 
A. 45:549 (Nov.) 1958. Menger, 
H. C.i New York J. Med. 58:1684' 
(May 15) 1958. Farah, L: Inter- 
nat. Rec. Med. 169:379 (June) 
1956. 

SUPPLIED: Tablets, 10 mg., 25 
mg., 100 mg.; bottles of 100. 
Syrup (10 mg. per tsp.), pint 
bottles. Parenteral Solution: 25 
mg./cc. in 10 cc. multiple-dose 
vials; 50 mg./cc. in 2 cc. am- 
pules. 



J 






IN ORAL CONTROL OF PAIN 



ACTS FASTER-usua I ly within 5-15 minutes. LASTS LONGER-usually 
6 hours or more. MORE THOROUGH RELIEF- permits uninterrupted 
sleep through the night. RARELY CONSTIPATES-excellent for 
chronic or bedridden patients. 

average adult dose: 1 tablet every 6 hours. May be habit-forming. Federal law 
permits oral prescription. 

Each Percodan* Tablet contains 4.50 mg. dihydrohydroxycodeinone hydro- 
chloride, 0.38 mg. dihydrohydroxycodeinone terephthalate, 0.38 mg. homa- 
tropine terephthalate, 224 mg: acetylsalicylic acid, 160 mg. phenacetin, and 
32 mg. caffeine. 

Also available — for greater flexibility in dosage - Percodan®-Demi: The 
Percodan formula with one-half the amount of salts of dihydrohydroxyco- 
deinone and homatropine. 

Literature? Write 

ENDO LABORATORIES 

Richmond Hill 18, New York 



$«S 



Percodan 

Salts of Dihydrohydroxycodeinone and Homatropine, plus APC 



Tablets 



FOR PAIN 




•U.S. Pat. 2,628,185 



July, 1960 



ADVERTISEMENTS 



XXI 



I 



ECLOMYCIN NOTES: 



Demethylchiortetracycllne Ledefle 



pathogen 

sensitivity 



In addition to the expected broad- 
spectrum range of effectiveness, 
Declomycin has demonstrated ac- 
tivity against strains of Pseudomo- 
nas, Proteus and A. aero g enes un- 



responsive 

refractory 

antibiotics. 



1. Finland, M.; Hlrsch, H. A., and Kunin, C. 
M.: Read at Seventh Annual Antibiotics Sym- 
posium, Washington, D. C, November 5, 
1959. 2. Hirsch, H. A.; Kunin, C. M., and 
Finland, M.: Miinchen. med. Wchnschr. To be 
published. 3. Roberts, M. S.; Seneca, H., and 
Lattimer, J. K.: Read at Seventh Annual 
Antibiotics Symposium, Washington, D. C, 
November 5, 1959. 4. Vineyard, J. P.; Hogan, 
J., and Sanford, J. P.: Ibid. 

Capsules, 150 mg. — Pediatric Drops, 60 
mg./cc. — New Syrup, cherry-flavored, 75 / 
mg./5 cc. tsp., in 2 fl. oz. bottle — 3-6 mg. 
per lb. daily in four divided doses. 



A. 
aerogenes 



or highly 



Xto other 

reeudomonas)' 




GREATER ACTIVITY... FAR LESS ANTIBIOTIC ... SUSTAINED-PEAK CONTROL ... "EXTRA-DAY" PROTECTION AGAINST RELAPSE 

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York 



XXII 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



For topical infections, 

choose a 'B. W. & Co." 'SPORIN'. . . 



.— / 




CORTISPORIN 



brand OINTMENT 



Combines the anti- 
inflammatory effect 
of hydrocortisone with 
the comprehensive 
bactericidal action 
of the antibiotics. 






Each gram contains: Neomycin Sulfate 5 mg. 

'Aerosporin'® brand Polymyxin B Sulfate 5,000 Units Hydrocortisone (1%) 10 m S- 

Zinc Bacitracin 400 Units in a special petrolatum base. 




Each gram contains: 

'Aerosporin'® brand Polymyxin B Sulfate 5,000 Units Zinc Bacitracin 

Neomycin Sulfate 5 mg. in a special petrolatum base. 



400 Units 




V.. 



POLYSPORIN' 

brand ANTIBIOTIC OINTMENT 



Offers combined anti- 
biotic action for treating 
conditions due to suscep- 
tible organisms amenable 
to local medication. 



u 



Each gram contains: 

'Aerosporin'® brand Zinc Bacitracin 500 Units 

Polymyxin B Sulfate 10,000 Units in a special petrolatum base. 



BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N. Y. 




• ••••• 



isual medications 
act only here 



u w| 



p» • • 




elief in HAY FEVER 



*% . 



« 



.**) 



■ 



3«« 



NEW 




\ 



• • 



acts here 



to relieve both nasal 



and chest discomfort 



»» •••« 







', 






BHL- 



I m L» V v 





/upper respiratory decongestion 
and bronchial decongestion 

Many hay fever patients also experience chest discomfort. For these patients, 

new ISOCLOR provides relief along the entire respiratory tract. 

COMBINES the nasal and bronchial decongestant action of d-isoephedrine with 

the histamine blocking action of chlorpheniramine. 

RELIEVES the discomforts of rhinorrhea, itching, sneezing, hyperlacrimation 

and post nasal drip— let s the patient get a full night's rest— with minimal daytime 

drowsiness, CNS or pressor stimulation. 

TABLETS AND SYRUP for adults and children . . . 
COMPOSITION: Per tablet Per 5 ml. syrup 

Chlorpheniramine maleate 4 mg. 2 mg. - _ . . . — P T n II T 

d-lsoephedrine HCI 25 mg. 12.5 mg. AKNAK'olUNt 

DOSE: Tablets: One tablet 3 or 4 times daily. Syrup: Children: 3-6 yrs. Laboratories InC 

'/; tsp. t.i.d.; 6-12 yrs. 1 tsp. t.i.d.; Adults: 2 tsp. t.i.d. 

AVAILABLE: Tablets: Bottles of 100. Syrup: Pint bottles. Mt. Prospect, Illinois 



\j*t-fifjfl 


V' : 


fi|nH '^iM 


K ■ 




1 ^K ■ 


1 '■ lifaff ^A 






3Ht.3B», 



ffiH^ 



^V*tr~'. 



'8[* ■ - 



! « 







"Tfo amc^tf of treating hypertension with a potent oral diuretic in combination 
with one or more of the sympathetic depressant drugs is a new one." 

Salutensin samples available on request 



Gentlemfn: Please send me a complimentary supply of 
Salutf.nsin Tablets. 



Dr.. 



Street_ 
City 



_ZONE_ 



_State_ 



Signature. 



Send coupon to: Bristol Laboratories, Syracuse, New York. 



REFERENCES: 1. Gifford, R. 
W., Jr., In Hypertension, ed. by 
J. H. Moyer, Saunders, Philadel- 
phia, 1959, p. 561. 2. Moyer, 
J. H.: Ibid. p. 299. 3. Brodie, 
B. B.: In Hypertension, Vol. VII, 
Proceedings Council for High 
Blood Pressure Research, Am. 
Heart Assn., ed. by F. R. Skelton, 
1959, p. 82. 4. Wilkins, R. W.: 
Ann. Int. Med. 50:1, 1959. 5. 
Freis, E. D.: In Hypertension, ed. 
by Moyer, op. cit., p. 123. 6. 
Ford, R. V., and Nickell, J.: Ant. 
Med. » Clin. Ther. 6:461, 1959. 
7. Fuchs, M., and Mallin, S. R.: 
Int. Red. Med. 172:438, 1959. 



NEW 



For the "multi-system disease" 2 HYPERTENSION, 
an integrated multi-therapeutic antihypertensive... 




A multi-system disease such as essential hypertension often requires a multi-therapeutic approach (or satisfactory 
control. Salutensin combines in balanced proportions three clinically proven antihypertensives. These components 
act through three different physiologic mechanisms to offer greater therapeutic benefits while minimizing the risk of 
side effects sometimes observed in patients on single drug therapy at maximally effective doses. The components in 
each Salutensin Tablet: 

Saluron (hydroflumethiazide Bristol) — a saluretic-antihypertensive agent postulated to lower elevated blood pres- 
sure by affecting vascular reactivity to a still unknown pressor mechanism 50 mg. 

Reserpine — a tranquilizing drug with peripheral vasorelaxant effects, which have been described as a "chemical 

sympathectomy" 3 0.125 mg. 

Protoveratrine A—"& potent hypotensive drug" 4 which is "well tolerated" in combination with rauwolfia; 4 a cen- 
trally mediated vasorelaxant that produces "the most physiologic, hemodynamic reversal of hypertension" 5 .. ..0.2 mg. 

Indications: Essential hypertension; hypertensive cardiovascular disease; insufficient response to a single or dual 
antihypertensive agent; partial or complete replacement of potentially more toxic agents. 

Salutensin should be used cautiously in hypertensive patients with renal insufficiency, particularly if such patients 
are digitalized. 

Dosage: Usual adult dose 1 tablet twice daily. Detailed information on dosage and precautions in official package 
circular or available on request. 

ply: Bottles of 60 scored tablets. 



A sustained-action foundation drug for an antihypertensive regimen 

saLuroN 




sustained-action hydroflumethiazide 'Bristol' 

Saluron is an economical, well-tolerated salutensive agent — saluretic and antihypertensive — for 
foundation drug in the treatment of hypertension. In mild to moderate hypertension, Saluron 
adequate by itself. It has been described as "a distinct advantage in the manifestations of hypert 
and "a marked advancement in the field of diuretic therapy." 7 

Dosage: Usually 1 tablet daily. Full information in official package circular. 

SurrLY: Scored 50-mg. tablets, bottles of 50. 

BRISTOL LABORATORIES, Syracuse, New York 



use as a 
often is 
ension" 6 



XXVI NORTH CAROLINA MEDICAL JOURNAL July, 1960 



FOR 

SULFONAMIDE 
THERAPY 




NEW 



DR4P 
DOSAGE 
F*RM 
CHERRY 
FLAVORED 




N Acetyl Sulfamethoxypyridazine 

PEDIATRIC DROPS 

I I single, daily-dose effectiveness □ rapid, 
sustained action against sulfa-susceptible 
organisms □ 125 mg. sulfamethoxypyrida- 
zine activity per cc. in 10 cc. squeeze bottle 

Dosage: First day, 2 cc. (250 mg.) for each 20 lbs. body weight; thereafter, 1 cc. 
(125 mg.) for each 20 lbs- Should be given once a day immediately after a meal. 

LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York 







■ .• 



Of course, women like "Premarin" 



rpHERAPY for the menopause syn- 
■*■ drome should relieve not only the 
psychic instability attendant the con- 
dition, but the vasomotor instability 
ot estrogen decline as well. Though 
they would have a hard time explain- 
ing it in such medical terms, this is 
the reason women like "Premarin." 
The patient isn't alone in her de- 



votion to this natural estrogen. Doc- 
tors, husbands, and family all like 
what it does for the patient, the wife, 
and the homemaker. 

When, because of the menopause, 
the psyche needs nursing— "Premarin" 
nurses. When hot flushes need sup- 
pressing, "Premarin" suppresses. In 
short, when you want to treat the 



whole menopause, (and how else is 
it to be treated?), let your choice be 
"Premarin," a complete natural es- 
trogen complex. 

"Premarin," conjugated estrogens 
(equine), is available as tablets and 
liquid, and also in combination with 
meprobamate or methyltestosterone. 
Ayerst Laboratories* New York /~~~\ 3 
16, N. Y. • Montreal, Canada \^»0 " 



^AL potassium phenethicillin 




YNCI 



J 



LIN 

(Potassium Penicilliu-152) 





higher peak blood levels 

than with potassium penicillin V 

higher initial peak blood levels 
than with intramuscular penicillin G 



increased dosage increases 
serum levels proportionally 



superior to other penicillins 
in killing many staph strains 



A dosage form to meet the individual 
requirements of patients of all ages 
in home, office, clinic and hospital: 

Syncillin Tablets-250 nig. . . . Syncillin Tablets-125 mg. 

Syncillin for Oral Solution — 60 nil. bottles— when reconstituted, 
125 nig. per 5 ml. 

Syncillin Pediatric Drops — 1.5 Gni. bottles. Calibrated dropper 
delivers 125 nig. 

Complete information on indications, dosage and precautions is 
included in the official circular accompanying each package. 




clears ringworm orally regardless of duration 
or previous resistance to treatment 

spares the patient— embarrassment of epilation and 
skullcaps, difficulty and ineffectiveness of topical 
medications, potential hazard of x-ray treatments 



XXX 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



Co-Pyronir 

keeps most allergic patients 
symptom-free around the clock 




Many allergic patients require only one Pulvule® Co-Pyronil 
every twelve* hours, because Co-Pyronil provides: 

• Prolonged antihistaminic action 

• Fast antihistaminic action 

plus 

• Safe, effective sympathomimetic therapy 

*Unusually severe allergic conditions may require more fre- 
quent administration. Co-Pyronil rarely causes sedation and, 
even in high dosage, has a very low incidence of side-effects. 

Supplied as Pulvules, Suspension, and 
Pediatric Pulvules. 

Co-Pyronil" (pyrrobutamine compound, Lilly) 




ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A. 

658012 



North Carolina Medical Journal 

Owned and Published by 
The Medical Society of the State of North Carolina 



Volume 21 



July, 1960 



No. 7 



Presidents Inaugural Address 



Amos N. Johnson, M.D. 
Garland 



I am grateful to you for having elected 
me to be your president. I repeat the words 
of Dr. Paul McCain on the occasion of his 
inauguration: "To have been selected and 
elected to leadership by those people who 
know you best, your fellow physicians, is 
the highest honor that can come to anyone" ; 
and I am grateful for it. As I now assume 
this responsibility and honor, I am mindful 
of many things. 

I am mindful of the constant and contin- 
uous change that is going on in this world 
and of the rapidity with which events move 
| from day to day. 

I am also mindful that there is a cancer 
eating at Medicine continuously — a social, 
a political, and an economic cancer that 
we must watch and attempt to eradicate. 
It is invading the profession from the 
periphery, from the heart, from the inside, 
from within Medicine itself. 

I am mindful that when one person or 
one group loses its freedom, the freedom of 
all people is weakened; that abject and un- 
reasoning conformity is the first symptom 
of mediocrity and eventual decay. Someone 
said that he who dares stick his head above 
the flowing tide of mediocrity is sure to 
have something thrown at him, but I say to 
you that it is only by continued, tireless ef- 
fort to rise above the commonplace and to 
produce something of excellence that one 
attains success. Therefore I pledge to you 
that this year I will make every effort, with 
your help and the help of our capable staff 
in Raleigh, to keep the head of Medicine 
above the level of mediocrity, even though 
I may be fired upon. And, in the sniping at 
me, medicine may be jarred a bit, but we 
will engage our enemy and find his position 
and strength wherever he is recognized. 



Read before the Second General Session, Medical Society of 
the State of North Carolina. Raleigh, May 11. 1960. 



Legislative Issues 
I must mention some of the issues which 
we will have to face this year. You have 
heard the discussions relative to legislation 
affecting medicine. In this day of govern- 
ment coddling minority groups, medicine is 
the whipping boy. Why? Because the poli- 
ticians who run our country think that 
more votes can be gained by maligning us 
and making us the villains than by shower- 
ing us with favors. So we are a unique min- 
ority who must be constantly alert to tell 
our story to all with whom we come in con- 
tact. Today's trend in Washington, as de- 
picted on television, radio and the press, is 
for Government to be all things to all peo- 
ple, to give everything to everybody. That 
is why we must be diligent in making our 
cause known. We must educate and in- 
fluence our politicians before they give 
away the privileges and financial security 
of all the people in this country. 

Integration of Negro Physicians 
Concerning the integration of Negro 
physicians into the Medical Society of the 
State of North Carolina, I have secured the 
original copy of the report filed by the com- 
mittee appointed by President Zack Owens 
to study this problem. In brief, the report 
states that a thorough study and meeting 
of minds between this committee and em- 
powered representatives of the Old North 
State Medical Society resulted in the con- 
clusion that there was a difference in the 
social structure of the races which pre- 
cluded integration at a social level, but 
that there was a need and a desire to make 
the scientific facilities of this Society avail- 
able to physicians of the Negro race. A 
statement of agreement was then reached : a 
statement which gave these colored phy- 
sicians every thing they asked and every 
thing they implied they needed. They were 
given access to the American Medical As- 



262 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



sociation and national specialty boards 
through scientific membership in our State 
Society; access to the North Carolina ex- 
amining and licensing board by the priv- 
ilege of nominating candidates and voting 
in these elections. 

After all this, we have two scientific 
members. Every Negro doctor in North 
Carolina could belong to our Society and 
could be sitting there with you today ; how- 
ever, of this privilege only two have availed 
themselves, and neither of them have I 
ever seen at a scientific session. After the 
original agreement was reached, their atti- 
tude quickly changed, probably touched by 
an outside influence persuasive enough to 
make them decide that they didn't get what 
they really wanted the first time. Now, 
after a short four or five years, they come 
back and want full membership. 

I say to you that it is not we, the mem- 
bers of the Medical Society of the State of 
North Carolina, who will bear the onus of 
what will happen as a result of the un- 
pleasantness that is sure to come. We have 
not broken the faith ; they, the members of 
the Old North State Medical Society, have 
broken the faith under the pressure and 
duress of the NAACP, whose sole purpose 
is to foment trouble, unrest and disorder. 

That brings us up to the point at hand. 
You take my word that what I have told you 
is true, that we went the full distance, the 
last mile. They want to dance with us, they 
want to sit at our banquet tables, they 
want to associate with us socially. Now, 
maybe it is all right for them to want that. 
I cannot judge, since I cannot put myself 
in their position. My perspective must 
necessarily be purely objective. But when 
I go back and think of what is basically 
right and on what grounds they have to de- 
mand this, I think of other creatures of na- 
ture. The tiger doesn't consort with the 
lion when sundown comes. Each goes to 
his own den. The fox doesn't knock on the 
kennel door to lie down with the hound, 
though they are closely related. The duck 
and swan do not fly North together. I do 
not know that there is any sociologic or bio- 
logic law that says we must integrate two 
elements of our society that are presently 
as separate and diverse as are these two 
races. 



We now have the problem of what to do. 
First, I propose to reactivate and enlarge 
the committee appointed by Dr. Owens. I 
propose to strengthen it, to confer with it 
and ask it then to study and recommend 
what we can do as a Society to meet this 
situation. It occurs to me that we can do 
two things : We can stand our ground, for 
I cannot see that we have erred. We can 
say to our Negro physicians : "You can 
have scientific membership. That entitles 
you to participate, nominate, and vote. That 
entitles you to all privileges except social 
functions." Or, we can do as other groups 
have done. We can leave this organization, 
the Medical Society of the State of North 
Carolina, exactly as it is now and, without 
change of constitution or by-laws, omit all 
social functions. We can then, by whatever 
maneuver is necessary, make membership 
in the Society tie in with license to practice 
medicine in North Carolina and require 
membership and regular attendance at 
meetings. Then we can be assured of hav- 
ing our brethren with us for scientific ses- 
sions. If we desire to have social functions, 
and no doubt we will, this can be accom- 
plished by invitation only under the aus- 
pice of some other organization. 

Other Considerations 

There are other things of which I am 
mindful. The format of our Annual Meet- 
ing will be changed, as authorized by the 
House of Delegates. We will hold perhaps 
three general sessions in the mornings, 
with a program which would have contin- 
uity of a sort involving the areas of the 
specialty sections. It would be a broad- 
spectrum program, and participating in it 
would be surgeons, internists, pathologists, 
radiologists, and others. 

If time permitted, I would discuss with 
you in some detail other matters of interest. 
However, I will briefly mention one or two 
of most interest. 

Dr. Wilburt Davison, who is soon to re- 
tire as Dean of the Duke University School 
of Medicine, is proposing a change in the 
accepted plan for the first year internship 
in North Carolina. This plan would set up 
an acceptable teaching and training pro- 
gram in our better community general hos- 
pitals. Each of our three medical schools 
would, by agreement, discontinue their one 
year of internship and run only a residency 






July, 1960 



263 




Amos N. Johnson, M.D. 



264 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



training program. This change would chan- 
nel, for one year at least, young doctors 
through hospitals whose major purpose is 
to treat and alleviate disease and suffering. 
This could give these young men a better 
perspective upon which to decide their fu- 
ture interest and training as physicians. 
Much work, salesmanship, and persuasion 
will be required if this excellent idea is ever 
put into practice. 

Dr. Wingate Johnson, editor of your 
North Carolina Medical Journal, has 
assured me that I will be given a page in 



every issue of our Journal this year. I 
promise you that I will use this page in 
each issue to keep you abreast of problems 
and progress of our Medical Society as I see 
them. Some ideas and proposed innova- 
tions may be controversial; however, their 
purpose will be to escape from conformity 
and mediocrity. I will at all times welcome 
comments and ideas from all our member- 
ship. 

Again I am grateful to you for permit- 
ting me the honor of appearing before you. 



Bad Politics and Good Medicine Don't Mix 



Louis M. Orr, M.D. 
Orlando, Florida 



It was with a certain amount of sorrow 
that I read in the newspapers recently that 
Congressman Aime Forand will retire from 
Congress at the end of his present term for 
reasons of health. As a newspaper report 
of the story said : "His doctors wanted him 
to quit two years ago." Of course, all of us 
hate to see Mr. Forand go. But on the 
other hand, as physicians, we are obliged 
to regret that he did not follow his doctors' 
advice two years ago. 

Unfortunately, the legislation that has 
become identified with Mr. Forand will not 
be retired with him. We know that other 
bills providing health insurance for the 
elderly — financed through Social Security — 
will be around Congress for some time to 
come. There seems to be a general belief 
among the pseudo-philanthropists in Wash- 
ing-ton that the only way to help the aged 
meet their medical and hospital bills is to 
soak the rest of the population by raising 
the Social Security taxes. This belief seems 
to be so untouchable that it is now an un- 
official creed of some politicians, and any- 
one who does not subscribe to it is branded 
as inhuman and callous. 

As you know, many different bills have 
been introduced in both houses of Congress 
in recent months to provide some form of 
help to the elderly. Those measures which 
*veuld saddle the taxpayer and wage- 
earner with the bill are enthusiastically 
hailed by Forand supporters. 



Presented at the President's Dinner, before Medical Society 
of the State of North Carolina. Raleigh. May 10. 1960. 



From the midst of all the politicking and 
pompous oratory surrounding such mea- 
sures, one crude fact emerges : Health care 
for the aged has become a political issue, 
and it will be used to campaign for votes 
in the fall. Personally, I regard this as a 
wretched example of political expediency. 
It has been obvious for several months 
that, in the absence of any strong issues, 
the coming national elections might be 
rather dull this year. Consequently, the 
question of health care for the aged has 
been seized upon as a seemingly clear-cut 
issue . . . something to get emotional about 
. . . something to win votes with. 

In the course of all this, physicians in 
general and the American Medical Associa- 
tion in particular have been villified for 
not endorsing these measures. Because we 
oppose the Forand bill and similar mea- 
sures, we are called heartless scoundrels. 
It is implied that we are fighting tooth- 
and-nail to keep the nation's elderly in a 
condition of abject poverty, without medi- 
cal care. 

Of course this is nonsense. There is no 
doubt that we have opposed Forand-type 
legislation. However, we have never said 
we opposed helping the aged meet their 
medical and health expenses. While we are 
very willing to consider reasonable pro- 
posals which would result in actually help- 
ing the aged, we can see no reason why the 
government must pick the pockets of the 
younger generation to pay for the health 
care of the old people. I make the point of 



July, 1960 



POLITICS AND MEDICINE— ORE 



205 



our willingness to consider sound measures 
because it will clarify what I plan to say- 
in a few minutes. 

This entire question of government medi- 
cine is a radical departure from the tradi- 
tions which raised the United States to 
such greatness. Throughout history our 
nation has championed the voluntary ap- 
proach to health and medical care. Our 
physicians have functioned on an unre- 
stricted, private basis, either as solo prac- 
titioners or in a group of doctors forming 
a clinic or group practice. We always have 
spurned any form of national compulsory 
health care. 

In recent years, however, our federal 
government has been taking an increased 
interest in health and medical matters. 
This interest has manifested itself along 
lines we are convinced would be dangerous 
for the health of the nation. For example, 
just since 1953 a total of 2,194 health and 
medical bills have been introduced in Con- 
gress. This total does not include those that 
already have been introduced and will be 
offered in the second session of the present 
Congress. 

Veterans' Medical Care Program 

I could list any number of examples of 
the growing interest of Congress in health 
matters, but let us start with the veterans' 
medical care program in the United States. 
Let us take a quick look at what has hap- 
pened. 

The original motive for this program 
was the desire to provide care for any vet- 
eran who had become disabled while serv- 
ing his country. Such a desire was, and 
still is, a sound, humanitarian motive and 
a legitimate obligation of the federal gov- 
ernment. Over the last 35 years, however, 
the program has been expanded to provide 
care for the veteran who suffers a dis- 
ability after his discharge from service 
and one that has no relation to his military 
duty. The reasons for this expansion can 
be traced to politically motivated acts of 
our Congress, as well as to vigorous pres- 
sure by lobbying organizations. 

In 1917 legislation was first passed to 
provide medical services and supplies to 
veterans with service-connected disabilities. 
Six years later Congress broke the ice and 
authorized care for non-service-coymected 
cases, because some beds had become avail- 



able through a reduction in the load of pa- 
tients with service-connected conditions. 
This provision applied only to certain 
veterans. 

A year later, the doors were opened 
wider to include more veterans. Within two 
years (1926) 17 per cent of all patients in 
veterans hospitals were receiving treat- 
ment for diseases or injuries not related to 
military service. And in that year the 
doors to the veterans hospitals were swung 
completely open. 

Two years later (by 1928) 49 per cent 
of all admissions were for non-service- 
connected cases. By 1931 this figure had 
jumped to 71 per cent. In 1954 more than 
83 per cent of the patients discharged from 
veterans hospitals had disabilities not con- 
nected with military service. 

During the last 30 years the argument 
for care for non-service-connected cases 
has been that as long as extra or vacant 
beds are available, the beds should be used 
for indigent veterans who have non-service- 
connected disabilities or illnesses. Well, 30 
years ago our nation had only 9,500 "ex- 
tra" beds. Today there are more than 
80,000. 

The VA costs have skyrocketed from 37 
million dollars in 1934 to 843 million 
dollars in 1959. Perhaps even more impor- 
tant than the cost of this particular fed- 
eral program, however, is the development 
of greater federal control of our medical 
schools as the private teaching hospitals 
drop internships and residencies because 
of inability to compete with the VA hospi- 
tal inducements. And these are paid for by 
our tax dollars. I fear that federal pro- 
grams such as this can lead to a large num- 
ber of physicians whose total hospital ex- 
perience during their education will have 
been under the federal eye — from clinical 
clerkship to completion of residency. 

There are many, many more problems 
connected with the veterans program, but 
to examine each would take considerable 
time. From this brief discussion, however, 
you get some idea of the error in allowing 
the federal government to expand a legiti- 
mate program until it "covers the water- 
front." 

Health Plans and Social Security 
As I mentioned earlier, one of our major 
reasons for opposing Congressional health 



2lil> 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



schemes is because they would be operated 
under the Social Security Administration. 

When the Social Security Act became 
law in 1935, it contained 15 titles covering 
a wide range of subjects, including old age 
"insurance," aid to the blind, aid to de- 
pendent and crippled children, aid to the 
needy aged, grants for maternal and child 
welfare, and unemployment compensation. 

The A.M. A. has not taken any position 
before or since 1935 about the wisdom or 
desirability of the over-all Social Security 
program. In fact, the act might never have 
become a matter of concern to the medical 
profession had it remained in or near its 
original form. 

The act was amended drastically in 1939, 
particularly in regard to Title II, which 
covered old age insurance programs. Few 
substantial changes were made between 
1939 and 1950. Since then, however, the 
act has been amended substantially in 
every election year — 1952, 1954, 1956, and 
1958. 

The original provisions of Title II were 
designed to compel the employed worker to 
set aside a certain amount of his earnings 
for his old age. It applied primarily to 
workers in commerce and industry. The act 
did not and was not intended to cover self- 
employed persons, farmers or professional 
people, among others. 

Title II was originally limited to lump 
sum death benefits and monthly old age 
payments for covered employes who had 
paid into the system. Four years after 
adoption, the act was amended radically to 
allow monthly benefits for dependents and 
survivors. 

In 1950 some 10 million workers were 
brought under the protective wings of the 
Social Security Act, and in 1954 coverage 
was forced on farmers, lawyers, dentists, 
and additional farm and domestic em- 
ployes. State and local government em- 
ployes, ministers, and members of religious 
orders were offered a means to accept cov- 
erage voluntarily. 

The only large groups 
by the act are federal 
ployes — who have their 
program — and physicians. 

The A.M. A. has opposed inclusion of 
physicians for philosophic and economic 
reasons. Our philosophic arguments are 



not now covered 
government em- 
own retirement 



based on the theory, history and long-range 
prospects for social insurance systems. In 
other countries, such schemes have grown 
from retirement payments to survivorship 
payments to temporary cash sick benefits, 
and finally to national compulsory health 
insurance. 

In the United States, Social Security is 
following the same pattern. It has pro- 
gressed farther and farther away from its 
original purpose of providing financial 
protection for aged citizens and has moved 
closer and closer to the paternalistic, gov- 
ernment concept of "womb-to-tomb" cov- 
erage. 

Economically, few physicians would bene- 
fit from the retirement features of Social 
Security since most doctors continue work- 
ing long after their sixty-fifth birthdays. 
We in the A.M. A. also feel that our ap- 
proval of compulsory coverage would tend 
to dilute the strength of our continuing 
struggle against government medicine via 
amendments to the Social Security Act. It 
is well known that advocates of federal 
medicine have long envisioned the act as a 
vehicle for providing all-embracing gov- 
ernment health care. This ultimate objec- 
tive was openly presented to Congress in 
1943 when a national health insurance bill 
was introduced. Although it was not 
passed, versions of this 1943 legislation 
have been presented in every Congress 
since then. 

From 1948 to 1951 the bills received 
their greatest attention. It took a long and 
active campaign against this type of legis- 
lation by the medical profession and num- 
erous other groups to convince Congress 
that Americans wanted no part of govern- 
ment medicine. 

Government Medicine vs. 
Voluntary Insurance 

In our country, the government's medi- 
cal activities are on a massive scale, and 
they continue to grow. Last year for all 
health programs — research, medical care, 
public health — the government spent 62 
per cent more than it did five years before. 
Programs in 22 separate agencies and de- 
partments of the U. S. government range 
from cancer research to federal employee 
clinics. The total cost last year was about 
2 3/4 billion dollars. 



I 



July, 1960 



POLITICS AND MEDICINE— ORR 



267 



Today nearly 38 million persons are eli- 
gible to receive all or part of their medical 
care from or through the federal govern- 
ment. Both as a physician and as a tax- 
payer, I would like to know where this is 
going to stop ! 

In our country, nearly 125 million per- 
sons have some form of voluntary, non- 
government health insurance. This is about 
five out of every seven persons. And more 
and more persons are signing up for such 
health insurance coverage. 

So you see, this coin has two sides — on 
one side the federal government is expand- 
ing its activities in the medical care field, 
while on the other voluntary methods are 
providing more and better non-government 
health insurance for Americans. 

The American Medical Association be- 
lieves the voluntary system should be al- 
lowed to function freely and to provide for 
the health care needs of the American 



people. Our opponents sit back and whine: 
"Let the government do it." 

The medical profession, along with its 
many allies in the health field, is trying to 
halt the current piecemeal attempts to 
bring complete federal control of medical 
care and the medical profession. Already 
our opponents have made far too many 
gains, and the struggle has become a "do 
or die" fight to keep the private practice 
of medicine alive in the United States. 

Conclusion 
This, then, is the situation. I can promise 
you the A.M. A. will do all in its power to 
maintain the free enterprise system, the 
private practice system, and the voluntary 
approach to health and medical care. We 
will do so because these methods have 
brought to the American people the highest 
possible degree of medical care and knowl- 
edge, and it will bring them even greater 
care in the future. 



Three Great Challenges 

Leonard W. Larson, M.D.* 
Bismark, North Dakota 



As you know, American medicine is en- 
tering into a decade that may be its great- 
est — or its most disastrous. I am sure you 
are well aware of the innumerable chal- 
lenges and problems that lie ahead of us, 
many requiring our immediate attention. I 
want to speak about three of these chal- 
lenges. 

Medical Education 

One which requires careful study and 
the positive approach is the task of improv- 
ing both the quality and the quantity of 
our medical education facilities. Here, we 
must plan ahead to maintain an adequate 
supply of well trained physicians to meet 
the future medical needs of the American 
people. 

For the past 30 years or more, the pro- 
duction of new physicians by our medical 
schools has kept up with the nation's grow- 
ing population. Times are changing, how- 
ever, and we cannot be complacent. Our 



Read before the House of Delegates, Medical Society of the 
State of North Carolina. Raleigh. May 9. 1960. 

♦Chairman of the Board of Trustees. American Medical 
Association. 



population is increasing. Medical knowl- 
edge is expanding. Medical services are be- 
coming more complex. And the American 
people are showing greater interest in both 
the quality and availability of health 
services. 

In recent years there have been a num- 
ber of governmental and private studies 
involving the nation's future needs in med- 
ical manpower. These studies have pre- 
dicted approximately the numbers of phy- 
sicians and medical schools required by 
1975 and thereafter. Opinions differ on the 
variety of statistics and estimates, but 
there is agreement on the need for con- 
structive planning to meet future require- 
ments. Undoubtedly, it will be necessary to 
increase the annual number of medical 
school graduates. 

In December, 1958, the A.M. A. House of 
Delegates adopted a statement on the ex- 
pansion of American medical education. 
Existing medical schools were urged to con- 
sider increasing their enrollments and de- 
veloping new facilities. The House also en- 
couraged the creation of new four-year 



268 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



medical schools and two-year basic science 
programs by universities which can pro- 
vide the proper academic and clinical set- 
ting. This expansion, the House empha- 
sized, should be based upon careful, con- 
tinuing study of the changing needs in all 
categories of medical activity. 

In addition, the American Medical As- 
sociation is encouraging medical schools to 
experiment in new programs aimed at 
bringing about continual improvement in 
the quality and content of their curricula. 
For example, the new medical school stand- 
ards approved in June, 1957, are intended 
to provide flexible guides which will dis- 
courage excessive concern with standariza- 
tion, but which also will stimulate each 
medical faculty to provide a well integrated 
educational program in accordance with its 
own particular setting. 

Recruitment 

Meanwhile, the A.M. A. has developed an 
expanded career guidance program to re- 
cruit qualified, dedicated young people into 
the study of medicine. There is definite 
need for more intensive effort along these 
lines — from the national level all the way 
down to the grass roots of the doctor's 
home town or neighborhood. 

Too many superior students are attracted 
by other sciences which, in this age of 
electronics, nuclear energy and space ex- 
ploration, may seem more exciting or glam- 
orous. Others are drawn to careers which 
may appear to be more lucrative or more 
easily attained, or less demanding. Many 
of these young people are discouraged by 
the length and cost of a medical education. 

Recruitment and expansion in medical 
education are, of course, closely related 
problems. Recognizing this at the Dallas 
meeting last December, the A.M. A. House 
of Delegates approved the creation of a 
special committee to "present a scholarship 
program, its development, administration 
and the role of the American Medical As- 
sociation in fulfilling it." Such a program 
also could include provision for student 
loans. 

The same committee will study these 
seven other major questions: 

— How far can medical schools expand 
their student bodies while still maintaining 
a high quality of medical education? 

— What universities can support new 
medical schools with qualified students and 



sufficient clinical material for teaching — 
either on a two-year or a full four-year 
basis? 

— How to obtain competent medical fac- 
ulties? 

— How to finance the expansion and es- 
tablishment of medical schools? 

— How to finance medical education in 
the most economical ways commensurate 
with high quality training? 

— How to recruit well qualified students 
into the study of medicine . . . and, finally, 

— What are the possibilities of relaxing 
some of the geographic restrictions which 
affect the admission of medical school stu- 
dents? 

This new committee was asked to make 
its first report at the A.M. A. June meeting. 

I urge you and the entire profession — 
practicing physicians, teachers, adminis- 
trators, researchers, medical societies, pub- 
lic health personnel, and medical schools — 
to give full cooperation to this study. 
Through all possible channels I hope that 
you will make your ideas and suggestions 
available for this long-range project aimed 
at the continuing improvement of Ameri- 
can medical services. 

Third Parties 

Still another challenge to all of us is the 
task of bringing about better understand- 
ing and cooperation between medicine and 
the various third parties involved in med- 
ical care plans and health insurance. 

You may recall that last June the A.M. A. 
House of Delegates, in acting upon the 
recommendations of the Commission on 
Medical Care Plans, adopted these key 
statements on freedom of choice of physi- 
cian : 

The American Medical Association believes 
that free choice of physician is the right of 
every individual and one which he should be free 
to exercise as he chooses. 

Each individual should be accorded the priv- 
ilege to select and change his physician at will 
or to select his preferred system of medical 
care, and the American Medical Association 
vigorously supports the right of the individual 
to choose between these alternatives. 
Those statements were reaffirmed at the 
Dallas meeting last December. Some mem- 
bers of the profession felt, however, that 
there had been a certain degree of misun- 
derstanding or misinterpretation of the 






July, 1960 



THREE CHALLENGES— LARSON 



269 



action taken last June. Therefore, at the 
Dallas meeting, in order to clarify and 
strengthen its position on the issue of free- 
dom choice, the House also adopted this 
additional statement: 

Lest there be any misinterpretation, we state 
unequivocally that the American Medical Asso- 
ciation firmly subscribes to freedom of choice 
of physician and free competition anions: phy- 
sicians as being prerequisites to optimal med- 
ical care. The benefits of any system which pro- 
vides medical care must be judged on the degree 
to which it allows of, or abridges, such freedom 
of choice and such competition. 
In other words, the medical profession 
recognizes a person's right to choose the 
kind of medical care plan he wants — in- 
cluding a closed panel plan. At the same 
time we believe emphatically that the best 
medical care comes about when the patient 
has maximum freedom of choice and the 
doctor has maximum freedom of profes- 
sional action. I think, however, that all of 
us must do a much better job of explaining 
to the public, and to those who sponsor 
medical care or health insurance programs, 
just why these principles are vital to high 
quality medical service. 

I urge you to cooperate sincerely in all 
national, state and local activities aimed at 
bringing about better understanding. In my 
opinion, all of us should bear in mind that 
labor unions, industry, and other third 
parties in the medical care field are trying 
to meet a need under our American system 
of private enterprise. It seems to me that 
all of us — despite differences of opinion on 
certain points — should be working together 
in the fight against a common danger : gov- 
ernment encroachment which ultimately 
could destroy our entire system of private 
medicine and voluntary health insurance. 

Physician-Hospital Relationships 

Another difficult issue which concerns 
the entire medical profession is the problem 
of physician-hospital relationships. I would 
not attempt to cover all the complexities 
and variations of this subject, but again I 
ivoidd like to report to you on the latest 
policy developments in this area. 

1951 Guides for Conduct 

The A.M.A. House of Delegates, at the 
Dallas meeting received a dozen resolutions 
on the subject of physician-hospital rela- 
tionships. The House did not act upon any 



of those resolutions. Instead, to remove any 
doubt about its position, the House reaf- 
firmed the 1951 "Guides for Conduct of 
Physicians in Relationships with Institu- 
tions." It also declared that "all subsequent 
or inconsistent actions are considered su- 
perceded." 

If I may, I should like to refresh your 
memories by quoting just three brief para- 
graphs of those 1951 guides. They sum- 
marize general principles which should be 
used as a basis for adjusting controversies. 
Again I quote : 

1. A physician should not dispose of his pro- 
fessional attainments or services to any hospital, 
corporation or lay body by whatever name called 
or however organized under terms or conditions 
which permit the sale of the services of that 
physician by such agency for a fee. 

2. Where a hospital is not selling the services 
of a physician, the financial arrangement if any 
between the hospital and the physician properly 
may be placed on any mutually satisfactory 
basis. This refers to the remuneration of a phy- 
sician for teaching or research or charitable 
services or the like. Corporations or ■ither lay 
bodies properly may provide such services and 
employ or otherwise engage doctors for those 
purposes. 

3. The practice of anesthesiology, pathology, 
physical medicine and radiology are an integral 
part of the practice of medicine in the same 
category as the practice of surgery, internal 
medicine or any other designated field of medi- 
cine." 

In addition to reaffirming the 1951 
guides, the A.M.A. House of Delegates 
recommended that the medical profession 
strengthen relationships with hospitals by 
action at state and local levels. And, finally, 
it also urged the A.M.A. Board of Trustees 
to continue to maintain liaison with the 
American Hospital Association's Board of 
Trustees. 

This is a highly complex issue with legal 
and professional ramifications which vary 
greatly in different states and communities. 
In my own view, our best hope for sound, 
lasting solutions would be in developing 
effective liaison between physicians and 
hospitals at the state and local levels. 

Both of us — physicians and hospitals — 
must think primarily of public welfare and 
community responsibility. At the same 
time, we doctors have a duty to protect 
those ethics and traditions which contri- 



270 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



bute to high quality medical care, and 
which safeguard the patient against all 
possible kinds of exploitation. 

I hope that physicians everywhere will 
work especially hard to help bring about 
better communication and understanding 
on the state and local level. 



Conclusion 

Among the many challenges facing medi- 
cine, I have outlined but three — expansion 
of our medical education system, relation- 
ships with third parties, and physician-hos- 
pital relations. 

I am confident that my fellow physicians 
in North Carolina will measure up to these 
long, hard tasks ahead. 



Generalized Salivary Gland Virus Disease 
In Post>neonatal Life 



Charles F. Gilbert, M.D. 
Chapel Hill 



The clinical and pathologic features of 
generalized salivary gland virus disease in 
the newborn and adult are well known. It 
is not so well known that the disease has a 
post-neonatal phase in which the clinical 
and pathologic features have not been well 
denned. This hiatus in knowledge is due in 
part to the rarity with which the disease 
occurs in this age group. The following 
case is reported to emphasize some features 
of the post-neonatal phase of the disease 
and to indicate certain diagnostic methods 
which have been recently described. 

Neonatal Form 

The disease in the neonatal age group 
has two distinct forms. The first is asymp- 
tomatic involvement of the salivary glands, 
which is found in 10 to 30 per cent of un- 
selected autopsies. The second is the dis- 
seminated form, which presents a char- 
acteristic clinical picture and has an espe- 
cially high incidence in premature infants. 
The characteristic findings are jaundice, 
hepatosplenomegaly, cutaneous petechiae, 
anemia and thrombocytopenia, which are 
present at birth or develop within the next 
few days. The virus is pantropic, involving 
the kidneys, liver and lungs more common- 
ly, but frequently is present in the brain, 
pancreas, thyroid, gut or other organs. The 
mode of dissemination is thought to be 
transplacental, occurring early in the ges- 
tation. The mechanism liberating the virus 
from the mother's salivary glands and caus- 
ing the maternal and fetal viremia is un- 



From the Department of Pathology. University of North 
Carolina School of Medicine. Chapel Hill. 



known. An interesting feature is that the 
fetal organs receiving a large amount of 
blood are involved more frequently and 
more extensively. The prognosis in the dis- 
seminated disease is grave in contrast to 
that in the localized or asymptomatic forms. 

Adult Form 
Disseminated salivary gland virus dis- 
ease is extremely uncommon in adults, 
only 35 cases having been published in the 
world literature* 1 '. The disease has been re- 
ported only as a complication of a chronic 
debilitating disease or its treatment. A pri- 
mary neoplasm of the reticuloendothelial 
system, refractory anemia, leukemia, renal 
disease, and other less common debilitating 
diseases have been associated with a ma- 
jority of reported cases. The symptoms of 
the adult form are those of the primary 
disease and of respiratory distress second- 
ary to an interstitial pneumonia caused 
by the salivary gland virus. The pneumonia 
in many cases, both adult and neonatal, is 
associated with an infestation by Pneumo- 
cystis carinii. This latter organism is 
thought to be a protozoan, but its classifica- 
tion is uncertain. It is associated with 
salivary gland virus disease in up to 50 per 
cent of cases. 

Post-neonatal Form 
The disease in this age group differs 
somewhat from that of the newborn and 
the adult. It usually presents as a severe 
respiratory infection or gastroenteritis. 
Renal and hepatic dysfunction occur, but 
are less common. The disease is usually 
manifest between 2 and 4 months of age, 



July, 19G0 



SALIVARY GLAND VIRUS DISEASE— GILBERT 



271 



r 



but has a range of 3 weeks to 32 months' 2 '. 
Prematurity has not been correlated with 
the development of the disease. As in the 
neonatal group, there has been, to date, an 
unrelenting progression of symptoms until 
death, which may be as long as two or 
three months. 

The organ involvement in this age group 
is similar to that of the newborn. The lungs, 
kidneys, and liver are commonly affected, 
and other organs less frequently. As in the 
present case, the clinical picture is not well 
denned, but the disease should be suspected 
in children with an unremitting pneumonia 
or gastrointestinal disturbance, especially if 
hepatosplenomegaly accompanies either. 

Development of the fulminant disease 
in newborn infants is apparently related to 
the fetal viremia and the inability of the 
infant to produce antibodies. The same 
factors may be present in adults with a 
chronic debilitating disease. Most cases in 
the post-neonatal period apparently have no 
precipitating illness. 

Case Report 

The patient was a 12 month old white 
girl referred to North Carolina Memorial 
Hospital because of stiffness and weakness 
of the right arm and leg observed since the 
age of 3 months. There had also been fail- 
ure to attain normal muscular development 
and skill. 

The child was the product of a normal 
pregnancy, but during the nine-hour labor 
arrest occurred, and she was delivered with 
low forceps. She cried spontaneously and 
her color was good. The mother and father 
were healthy and had no other children. 

On the first clinic visit, at 12 months of 
age, she weighed 21 V-> pounds and was 30% 
inches in length. The head circumference 
was 16 1/4 inches, slightly below the third 
percentile for her age. The right elbow and 
knee were flexed, and spasticity was pre- 
sent in these limbs. The right leg was y 2 
inch shorter than the left, but mobility at 
the hip joints was normal. There was a pos- 
sible homonymous hemianopsia on the right. 
An electroencephalogram had evidence of 
left cerebral damage. 

The patient returned at 14 months of age 
because of seizures characterized by sudden 
dropping forward from a sitting position, 
turning of the head toward the left, and 
clonic motions of the left leg. These lasted 



about 30 seconds. Occasionally vomiting 
followed. The seizures had begun 12 days 
prior to this visit, and occurred about five 
times a clay for the first five days, and 
thereafter about every half hour. The fam- 
ily physician had prescribed phenobarbital, 
following which the seizures became less 
frequent. The physical findings were un- 
changed. Because the seizures had contin- 
ued to occur, the dosage of phenobarbital 
was increased and Dilantin was also pre- 
scribed. 

She was admitted to this hospital at 15 14 
months of age because of an "urticarial- 
like" rash and fever which had been pre- 
sent for the previous 11 days. The rash had 
begun over the neck and upper trunk and 
finally spread over most of the body. Dilan- 
tin was discontinued four days after the 
rash developed. About three days before 
admission her throat became red and she 
began to cough frequently. The white cell 
count then was 16,750, with 51 per cent 
segmented forms and 47 per cent lympho- 
cytes. She had retained little food. Her 
bowel movements had become more fre- 
quent and softer than usual, and she had 
urinated only twice a day for the previous 
three days. Her feet were swollen. 

On admission the temperature was 101 F., 
pulse 110/min., respirations 20/min. and 
the weight was 20 pounds. The skin was 
covered with a partly confluent erythema- 
tous macular rash, with beginning desqua- 
mation in the diaper area. Axillary and in- 
guinal lymph nodes were slightly enlarged. 
The lungs were clear despite frequent 
coughing. The liver had descended 5 cm. 
below the right costal margin. The hands 
and feet were moderately edematous. The 
neurologic findings had not changed. 

The hematocrit was 47 per cent, and the 
leukocyte count was 45,250 mm 3 , with 48 
per cent granulocytes, 25 per cent lympho- 
cytes and 17 per cent monocytes. Many of 
the monocytes and lymphocytes were atyp- 
ical and questionably immature. A test (fer- 
ric chloride) for phenylpyruvic acid in the 
urine was negative. A trace of albumin was 
present in the urine, with 10 to 15 leuko- 
cytes and an occasional erythrocyte. A 
growth of Escherichia coli was obtained 
from the urine culture. X-ray films of the 
skull were interpreted as showing micro- 
crania. 



272 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



Hospital course 

Hydrocortisone and intravenous fluids 
were given and improvement occurred dur- 
ing- the initial few days. After about two 
weeks, however, the patient began having 
up to 18 watery stools a day. The main 
problem during the remainder of her life 
was that of hydration and electrolyte bal- 
ance. The dermatitis improved at times, 
but eventually progressed to exfoliation, 
with superimposed bullous eruptions. On 
one occasion hemorrhagic vesicular lesions 
were present on the hands, arms, feet, buc- 
cal mucosa, and lips. Phenobarbital had 
been discontinued on admission, but there 
were no more seizures. In addition to ster- 
oids and intravenous fluids, she was given 
antibiotics and intravenous salt-poor albu- 
min and blood. Despite all efforts and med- 
ication, her condition slowly deteriorated. 
During the three months' hospitalization 
the blood urea nitrogen rose from 3 to 22 
mg. per 100 ml., the hematocrit decreased 
to 35 per cent, and the leukocyte count re- 
verted to normal. Platelets were present on 
all peripheral blood smears. Weight de- 
creased to 12 pounds, although edema of 
the extremities appeared to increase. The 
total proteins were 5.4 Gm. per 100 ml. 
with an albumin of 2.8 Gm. per 100 ml. On 
the day before death pulmonary edema and 
tachycardia developed and she became cy- 
anotic about the lips. Following the admin- 
istration of digoxin, morphine and oxygen, 
some improvement was noted, but she died 
shortly afterwards in apparent congestive 
heart failure. 

Autopsy findings 

At autopsy the body was markedly ca- 
chetic. Extensive areas of exfoliative der- 
matitis were scattered over the trunk and 
limbs; these were especially marked over 
the scalp. The lesions were slightly de- 
pressed and covered with a reddish-brown 
crust. The epidermis was lost in many 
fields and was replaced by a fibrinopurulent 
exudate containing gram positive cocci. In 
adjacent zones, vesicle formation and loss 
of the normal epidermal pattern were pre- 
sent. A chronic cellulitis was present in all 
areas examined. Neither intranuclear nor 
cytoplasmic inclusion bodies were present 
in any section of skin. 

Each pleural space contained 10 cc. of 
serous fluid, but no adhesions. The lungs 
were slightly heavy and remained distended 



after removal from the cavity. The pleural 
surfaces were normal. The cut surfaces of 
the lungs were wet and exuded a slight 
amount of frothy fluid on compression. A 
generalized chronic interstitial pneumonia 
with focal areas of atelectasis was present. 
Scattered throughout the alveolar spaces 
were large cells measuring 30 to 40 micra 
in diameter (figs. 1, 2). They contained dis- 
tinct oval or rounded nuclear inclusion 
bodies which were about 10 micra in di- 
ameter and surrounded by an optically 
clear halo. The cytoplasm was eosinophilic 
and contained irregular basophilic inclu- 
sion bodies. The inclusion bodies stained 
well with hematoxylin and eosin. 

The heart and great vessels were normal. 

The abdominal organs were grossly 
normal but small for the patient's age. The 
liver had a normal lobular pattern, but 
contained many small foci of hematopoietic 
cells. Intranuclear or cytoplasmic inclusion 
bodies were not found. 

The kidneys were normal grossly, but the 
anatomic pattern was that of a newborn 
infant : the glomerular tufts were com- 
posed mainly of large cuboidal cells rather 
than the flattened epithelium seen in nor- 
mal infants of this age. The epithelial layer 
of most capsules was composed of similar 
cells. Many of the tubules were dilated, and 
in some fields the epithelial cells were large 
and contained intranuclear and cytoplasmic 
inclusion bodies identical to those described 
in the lungs (fig. 3). The inclusions were 
less frequent than in the lungs and were 
present mainly in the proximal tubular 
cells. 

Examination of tissue from the thyroid, 
parathyroid, thymus, lymph nodes, skin, in- 
testinal tract, bone marrow, adrenal glands, 
pancreas and spleen failed to reveal cellu- 
lar inclusion bodies. Permission for exam- 
ination of the central nervous system was 
not obtained. The salivary glands were not 
removed because the nature of the disease 
was not suspected at the time of autopsy. 
Cultures for viruses were not made. 

Comment 
The most interesting feature of the pre- 
sent case is that of the severe, unremitting 
diarrhea. A correlation of diarrhea with 
intestinal involvement is difficult, since 
diarrhea has been reported both in the ab- ■ 
sence and presence of inclusion bodies' 3 '. 
In some cases, moreover, typical nuclear in- 



July, 1960 



SALIVARY GLAND VIRUS DISEASE— GILBERT 



272 





»' • w5S-*4*J .•*/■'-■.- «->-.*. i* s s:v*- , '**v." l **.L « ._.* * " • • Ti v 



Fig. 1. Photomicrograph of the lung demonstrat- 
ing the large intra-alveolar cells containing nuclear 
and cytoplasmic inclusion bodies. A marked inter- 
stitial pneumonia is also present. (Hematoxylin and 
Eosin lOOx) 



Fig. 2. The nuclear and cytoplasmic inclusion 
bodies characteristic of the disease are present in 
the giant mononuclear cells in the alveolus. 
(Hematoxylin and Eosin 400x) 



inclusions were found in the gastrointestinal 
cosa when diarrhea is absent. Though no 
inclusions were found in the gastrointinal 
tract, the diarrhea could have been a man- 
ifestation of the generalized disease. 

The dermatitis was thought to be a sen- 
sitivity reaction to either Dilantin or phen- 
obarbital and probably not related to the 
salivary gland virus disease. In several re- 
ported cases, however, a dermatitis has 
been described (3>4) ; and in one, typical in- 
clusion cells were present in the sweat 
glands' 5 '. 

Evidence of renal impairment was sug- 
gested by an increasing blood urea nitro- 
gen, and by slight amounts of albumin and 
leukocytes in the urinary sediment. There 
was no evidence of a bleeding tendency ex- 
cept on the one occasion when hemorrhagic 
vesicles developed over portions of the 
body. The hepatomegaly was secondary to 
congestion and foci of hematopoietic cells; 
such foci are notable features in many 
cases. The splenomegaly was secondary to 
congestion only. Organs other than the 




^* • 



r< 



i) 



'• * vfc,,w 



% 



c- 



? 



9 















W k 



i<Jj\ 



9%9 



e 



J*u% 



• a: 



° ■ * r e ^Lm a • 

Fig. 3. Dilated proximal tubule of the kidney 
containing large cells >vith nuclear and cytoplas- 
mic inclusion bodies. (Hematoxylin and Eosin 600x) 



274 



NORTH CAROLINA MEDICAL JOURNAL 



July, 19G0 



lungs and kidneys did not contain typical 
cellular inclusion bodies. 

Correlation of the neurologic manifesta- 
tions and the microcrania of the present 
case with those of generalized salivary gland 
virus disease cannot be made since the cen- 
tral nervous system could not be examined. 
In patients with this disease, however, the 
brain sometimes shows typical cellular in- 
clusions and anomalous developments, sug- 
gesting that the neurologic disease in this 
case may have been due to a malformation 
related to the viral infection. Crome and 
France" 11 report one case associated with 
microgyria and refer to other documented 
cases with microgyria, hydrocephalus, peri- 
ventricular calcification, focal softening 
and hemorrhage, and other lesions. The 
periventricular calcification has important 
diagnostic implications and is discussed be- 
low. 

The factor or factors responsible for ac- 
tivation of the apparently latent infection 
in this child are not evident, as is true in 
most instances of the post-neonatal group. 
It is possible that the drug reaction low- 
ered cellular resistance and allowed a dor- 
mant, localized disease to become dissem- 
inated. It is also possible, however, that all 
signs and symptoms were related solely to 
dissemination of the salivary gland virus. 

Diagnosis 

In most cases the disease is rarely diag- 
nosed during- life. Hematologic studies are 
nonspecific, commonly showing a moderate 
lymphocytosis and slight immaturity of the 
leukocytes A normocytic anemia and 
thrombocytopenia occur in many neonatal 
cases. With renal involvement there may be 
a rise in blood urea nitrogen; albumin and 
leukocytes may be present in the urine. 
Liver function tests may detect parenchym- 
al cell damage. All of these abnormalities 
are nonspecific. 

The most specific means of diagnosis at 
the present is the demonstration by cyto- 
logic examination of inclusion-bearing cells. 
The typical cells may be found in the urine, 
bronchial secretions, or gastric washings. 
The kidneys are commonly involved in both 
the neonatal and post-neonatal phase, and 
the most rapid, simplest, and cheapest means 
of establishing a positive diagnosis in these 
age groups is by cytologic examination of 



the urinary sediment. In some post-neona- 
tal cases and in adult cases, examination of 
sputum or gastric washings may establish 
the diagnosis, since patients in these groups 
frequently have pulmonary involvement. 
Details of collection and preparation of 
specimens are given in the excellent review 
by Nelson and Wyatt 171 . With central nerv- 
ous system involvement, these cytologic 
methods applied to the cerebrospinal fluid 
may establish a diagnosis' Sl . Biopsy ma- 
terials from the liver, lungs, and kidneys 
have contained the typical inclusion bear- 
ing cells in routine paraffin sections. 

Radiologic diagnosis is dependent on the 
presence of periventricular calcifications 
which outline the lateral ventricles' 8 '. Re- 
covery of the virus by cultural methods has 
been successful 11 ", but at present only a 
few centers have the equipment necessary 
for this technique. 

Treatment 

There is no specific treatment. Antibio- 
tics, steroids, gamma globulins, and blood 
have been employed, but, in most cases, 
with disappointing results. It is not known 
whether gamma globulins and blood con- 
tain effective antibodies to the virus, but 
Rowe and others' 1 "' demonstrated comple- 
ment-fixing antibodies in 53 per cent of un- 
selected persons between 18 and 25 years of 
age and in 81 per cent of persons over the 
age of 35 years. In a group of newborn in- 
fants, 71 per cent had antibodies, whereas 
in the age group of 6 months to 2 years 
only 14 per cent had demonstrable anti- 
bodies. It has been suggested that pro- 
longed steroid and antibiotic therapy may 
further weaken the host's defense against 
the disease. 

Summary 

A case of generalized salivary gland 
virus disease occurring in the post-neonatal 
period is presented. A brief discussion of 
the important features in the neonatal, 
post-neonatal and adult forms of the disease 
is included. Recently developed means of 
making an antemortem diagnosis are dis- 
cussed. The value of cytologic examination 
of urine, sputum, or gastric washings in 
making such diagnoses is emphasized. 

References 

1. (a> Symmers, W. S. C: Generalized Cytomegalic In- 
clusion-body Disease Associated ■with Pneumocystis Pneu- 



July, 19(30 



SALIVARY GLAND VIRUS DISEASE— GILBERT 



275 



monia in Adults, J. Clin. Path. 13:1-21 (Jan.) 1960. (b) 
Capers, T. H. and Lee, D. : Pulmonary Cytomegalic In- 
clusion Disease in an Adult. Am. J. Clin. Path. 33:238- 
242 (March) 1960. 

Wyatt, J. P.. Saxton, J.. Lee. R. S., and Pinkerton, H.: 
Generalized Cytomegalic Inclusion Disease, J. Pe lint. 
36:271-294 (March) 1950. 

Allen, J. H.. and Riley, H. D., .lr.: Generalized Cyto- 
megalic Inclusion Disease, with Emphasis on Roentgen 
Diagnosis, Radiology 71:287-262 (Aug.) 1958. 

Medearis, D. N., Jr.: Cytomegalic Inclusion Disease; An 
Analysis of the Clinical Features Based on the Literature 
and 6 Additional Cases. Pediatrics 19:467-480 (March) 
1957. 



6. Worth, W. 



and Howard, H. L. : New Features of In- 



clusinn Disease of Infancy. Am. J. Path. 26:17-35 (Jan.) 
1950. 

6. Crome, L. and France. N. E. : Microgyria and Cytomega- 
lic Inclusion Disease in Infancy, J. Clin. Path. 12:427- 
434 (Sept.) 1959. 

7. Nelson, J. E., and Wyatt, J. P.: Salivary Gland Virus 
Disease, Medicine 38:223-241 (Sept.) 1959. 

8. McElfresh, A. E., and Arey, J. B.: Generalized Cyto- 
megalic Inclusion Disease, J. Pediat. 51:146-156 (Aug.) 
1957. 

9. Kluge, R. Cm Wicksman, R. S., and Weller. T. H.: Cy- 
tomegalic Inclusion Disease of the Newborn, Pediatrics 
25:35-39 (Jan.) 1960. 

10. Rowe, W. P., and others: Cytopathogenic Agent Resem- 
bling Human Salivary Gland Virus Recovered from Tissue 
Cultures on Human Adenoids, Proc. Soc. Exper. Biol. 
& Med. 92:418-424 (June) 1956. 



Antibiotic Resistant 
Pulmonary Staphylococcic Infections 

Captain George L. Calvy, MC, USN* 
Camp Lejeune 



Staphylococcic infections have been a 
challenging problem for many years. Be- 
cause of the wide distribution of staphylo- 
cocci in the environment and on human 
body surfaces, the problem will probably 
remain for a long time. 

Impressive evidence of penicillin's bac- 
tericidal potency was available soon after 
its introduction. Strains of bacteria grad- 
ually emerged, however, that exhibited re- 
sistance to this antibiotic. This was par- 
ticularly evident in the case of Staphylococ- 
cus aureus. Additional antibacterial agents 
were introduced only to lose much of their 
effectiveness as increasing numbers of these 
antibiotic-resistant strains appeared. The 
following outline lists known biologic char- 
acteristics of the staphylococcus which help 
explain its formidable nature. 
1. Toxins and Lysins 

a. Exotoxin (lethal toxin; potent; when elab- 
orated in vivo, its lethal effect appears to 
be delayed until a critical threshold dose 
has accumulated; associated with necrotic 
and hemolytic reactions in a majority of 
toxigenic strains of Staph, aureus.) 

b. Enterotoxin (potent toxin acting primarily 
upon the gastrointestinal tract) 

c. Dermonecrotic toxin (necrotizing toxin; 
hemolysin ? ) alpha, 2 

d. Hemolysin (alpha, beta, gamma, delta; rbc 
lysins) 



Read before the Second General Session, Medical Society of 
the State of North Carolina, Raleigh, May 11, 1960. 

*Commanding Officer, Naval Field Research Laboratory, 
Camp Lejeune, North Carolina. 



e. Fibrinolysin (dissolves fibrin clots; re- 
stricted essentially to coagulase-positive 
human strains) 

f. Leucocidin (destroys leucocytes) 
2. Enzymes 

a. Coagulase — regarded as the sine qua non 
for pathogenicity (coagulates citrated or 
oxalated plasma); also neutralizes the anti- 
bacterial activity of normal human serum 
for staphylococci). 

b. Hyaluronidase (attacks the mucopolysac- 
charide — hyaluronic acid — intracellular 
ground substance; "spreading factor") 

c. Staphylokinase (plasminogen activator) 

(fibrinolysin? ) 

d. Penicillinase. This is a notorious substance 
responsible for treatment failures (inac- 
tivates penicillin) 

e. Gelatinase 

f. Proteinase 

g. Lipase 

Note: Pathogenic human (often of hospital ori- 
gin), coagulase-positive staphylococci frequently 
belong to general phage group III, types 80/81. 
These strains can now be further identified by 
fluorescent antibody staining techniques. 

Hospital Experience 

An experience in a large general hospital 
points up facets of the problem' 11 . During 
a two-year period more than 40 cases of 
antibiotic-resistant staphylococcic pneumon- 
ia, principally due to a hospital-acquired 
strain, were diagnosed and treated. This 
hospital contained a large segment of long- 
term patients, and staphylococcic pneu- 
monia first appeared as a complication of 



276 



NORTH CAROLINA MEDICAL JOURNAL 



July. 191.0 



pre-existing- major diseases such as car- 
cinoma, lymphoma, and urologic disorders. 
In later instances, staphylococcic infection 
occurred postoperatively in more newly ar- 
rived patients, and suspicion was directed 
toward staff personnel, both medical and 
surgical, as well as nursing attendants, 
who might be carrying pathogenic strains 
and/ or hidden lesions (furuncles, boils, 
and so forth). Screening measures were in- 
stituted to identify these carriers and to 
limit the assignment and movement of such 
personnel. Finally, a sharp upsurge in in- 
cidence of staphylococcic infections oc- 
curred at the height of the Asian influenza 
epidemic in the fall of 1957. In addition to 
patients who acquired infections in hospi- 
tal, 1 medical officer, 1 nurse and 5 hospital 
corpsmen fell victim to staphylococcic 
pneumonia, emphasizing the communicable 
aspects of this disease problem. 

At the beginning of the Asian influenza 
epidemic, a significant number of known 
staphylococcic infections was present in the 
hospital. 

Cose 1 

The urgent and widespread character of this 
problem had previously been recognized when one 
of our young staff hospital men was stricken. He 
had suffered from a cold and had resorted to self- 
medication with several different antibiotics during 
a three-week period. During this time his fiancee, 
a hospital WAVE, was hospitalized for furuncu- 
losis, and he had also attended a patient with se- 
vere staphylococcic pneumonia. Shortly thereafter 
he was admitted to the sick list with pleuritic pain 
and signs of pneumonia. A chest roentgenogram on 
the morning he was admitted was interpreted as be- 
ing essentially negative. By afternoon extensive 
infiltration was demonstrable in the right base, 
and by the following morning radiographic find- 
ings revealed areas of consolidation and infiltra- 
tion involving the entire right lung with extensive 
involvement of the left lung. A positive blood cul- 
ture yielded coagulase positive Staphylococcus 
aureus, phage type 52-42B-80, 81, the so-called 
"hospital strain." Despite heroic measures he died 
on the third hospital day. 

This shocking case served to provoke the 
action outlined in table 1. 

The Pneumonia Team consisted of four 
medical officers who stood a telephone 
watch and were available as consultants 
around the clock. Whenever a patient sus- 
pected of having pneumonia was admitted, 
the medical officer got in touch with a mem- 
ber of the team and discussed the general 



Table 1 

Task Force Staphylococcus 

January 15, 1957 

I. Antibiotic Control Board — chloramphenicol. 

novobiocin and ristocetin reserved for severe 
infection 

II. Pneumonia team (telephone watch) 
III. Epidemiology center 

1. Epidemiology officer 

2. Sanitation technician 

3. Bacteriologist 

4. Representative from Medicine, Surgery, 
Genitourinary, Laboratory, and Nursing 
services. 

problem, the bacteriologic study of the spu- 
tum, and the radiologic changes. In this 
manner a constantly high level of clinical 
awareness of staphylococcic pneumonia was 
maintained. The theme of this operation 
was "do it yourself," for the admitting doc- 
tor collected and examined the sputum, in- 
terpreted his patient's x-ray films, and 
sought consultation at the earliest oppor- 
tunity. Diagnosis was made earlier and 
treatment was standardized ; tracheostomy 
was performed in 21 cases, both as a pre- 
cautionary and as an emergency procedure. 
These factors are believed to have contri- 
buted significantly to curbing the mortal- 
ity rate in this series. 

Hemolytic, coagulase-positive staphylo- 
coccic pneumonia may present as a ful- 
minant process terminating in death be- 
fore bacteriologic proof can be obtained. In 
such instances as case 1, large doses of in- 
travenous bactericidal antibiotics should be 
given while awaiting bacteriologic confir- 
mation. The following case highlights the 
multiple complications and therapeutic frus- 
trations that may attend a fulminant dis- 
seminated infection. 

Case 2 

A 21 year old white man was referred to the 
Medical Service because of pneumonia, etiology 
undetermined 1 - 1 . The history revealed that he had 
sustained a fracture of the second cervical verte- 
bra in an automobile accident. Treatment had con- 
sisted of "prophylactic penicillin and streptomy- 
cin" and tong traction. While he was receiving 
these antibiotics, a secondary infection of the 
scalp became evident. Generalized urticaria de- 
veloped, and penicillin was stopped. Two days 
later a fever of 106 F. and a nonproductive cough 
developed. The patient was then started on terra- 
mycin, 500 mg. given intravenously twice daily, 
with no effect. A roentgenogram of the chest re- 
vealed pneumonia in the right upper lobe. Intra- 



July, 1960 



PULMONARY STAPH INFECTIONS— CALVY 



277 



venous terramycin was continued for two days, 
during which time his condition deteriorated rap- 
idly. When received on the Medical Service he was 
semicomatose and cyanotic. 

A tracheostomy was performed and the aspirate 
cultured out hemolytic Staph, aureus, coagulase- 
positive. A culture of the scalp infection and 
blood cultures revealed the same organism. Chlor- 
amphenicol, 500 mg. given orally every four hours, 
was started (before the culture reports were ob- 
tained). During this time his condition worsened, 
with the rapid appearance of left ventricular fail- 
ure and cyanosis. Intravenous sulfadiazine, 3.75 
Gm. every 12 hours, was started; rapid digitaliza- 
tion and phlebotomy were performed, and respir- 
atory support was maintained by a Drinker res- 
pirator. During the next three days the temper- 
ature dropped by lysis, and objective improvement 
was evident; however, on the fourth day, semi- 
coma recurred. 

Sensitivity studies on the material previously 
obtained for culture revealed in vitro sensitivity 
to Aureomycin, bacitracin, chloramphenicol, ery- 
thromycin, nitrofurantoin, neomycin, tetracycline, 
hydrochloride, and novobiocin. In vitro resistance 
was found to dihydrostreptomycin, penicillin, poly- 
myxin B, terramycin, and sulfadiazine. Erythro- 
mycin, 200 mg. given every four hours intramus- 
cularly, and Aureomycin, 500 mg. every six houis 
by nasogastric tube, were administered, resulting in 
a drop of temperature to 102 to 103 F., where it 
remained. Under this regimen, however, the pneu- 
monic process extended to involve the entire right 
lung and the left upper lobe. 

On the fifth day of this phase of the regimen, the 
patient had a right spontaneous pneumothorax, 
with resulting pyothorax and open bronchopleural 
fistula. Subsequent antibiotics and chemical agents 
consisted of combinations of novobiocin, sulfadia- 
zine, erythromycin, and streptomycin, during 
which time the patient developed a persistent 
tachycardia of 150, pericardial friction rub, electro- 
cardiographic evidence of pericarditis, fixed spe- 
cific gravity of urine, and continuous albuminuria. 
Fever continued between 102 and 104 F., and the 
spleen became palpable. A full-blown septicemia 
was evident at this time. 

All values remained static until ristocetin, 1000 
mg. initially and 250 mg. every six hours, was 
started intravenously, in combination with the 
previously mentioned antibiotics. Ristocetin was 
continued with a gradual tapering in dosage for 
12 days, at which time fever dropped by lysis. 
Evidence of pericarditis disappeared, the spleen 
was no longer palpable, blood cultures became 
negative, dissemination of the pneumonic process 
appeared to be arrested, with localization of em- 
pyema pockets amenable to thoracentesis and 
closure of the bronchopleural fistula. Rapid sub- 
jective and objective improvement of the patient 
ensued. Intravenous ristocetin was discontinued 
after 12 days, and the patient was maintained on 



oral novobiocin, 500 mg. every six hours, for the 
next two months. 

This case demonstrates the gravity of a 
hospital-acquired staphylococcic pneumonia 
and its complications. Eighteen combina- 
tions of 10 different antibiotics and sulfa- 
diazine were used with- no apparent re- 
sponse except for transient response to sul- 
fadiazine, to which resistance quickly oc- 
curred. Erythromycin and novobiocin were 
ineffective; however, when ristocetin was 
added, clinical improvement was noted. 
This man was discharged fully recovered, 
and is carrying on at full activity. 

Radiologic characteristics 

Early in this experience it became evi- 
dent that there were radiologic character- 
istics peculiar to staphylococcic pneumonia, 
of high reliability in leading to diagnosis. 
Radiologic Findings 
Rapid Progression — in hours 
I. Early — small patches of consolidation 
II. Infiltration c circumscribed translucencies 

III. Pleural effusion 

IV. Typical — pneumatoceles 

V. Spontaneous tension pneumothorax c or s 
empyema 

Analysis of antibiotic sensitivities re- 
vealed most of the encountered organisms 
in our series to be resistant to the sulfona- 
mides, tetracyclines, streptomycin, and pen- 
icillin. 

Erythromycin, which enjoyed great pop- 
ularity in the surrounding community, 
was ineffective in dealing with our severe 
staphylococcic infections. The best thera- 
peutic results were obtained with chloram- 
phenicol and intravenously administered 
ristocetin. Vigorous supportive therapy in- 
cluded tracheostomy. Gamma globulin was 
administered to 16 patients as adjunctive 
therapy. 

An excellent report by Ede, Davis, and 
Holmes emphasized early surgical therapy 
for complications'"''. Pulmonary complica- 
tions encountered in our experience were 
pneumothorax, empyema, lung abscess, and 
tension cysts. Only 2 patients had signifi- 
cant respiratory disability after recovery. 

Comment 

A recent editorial in the Neiv England 
Journal of Medicine pointed out the critical 
role that combinations of antibiotics may 
have played in bringing about the present 
state of affairs' 41 . The most popular and at 
the same time most dangerous of the anti- 



278 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



biotic combinations is that of penicillin and 
streptomycin, employed to treat many cases 
when streptomycin is almost always redun- 
dant. Unfortunately, it also is used for the 
prophylaxis of infections which it rarely 
prevents. Instead, it has contributed to the 
occurrence and increased severity of anti- 
biotic-resistant infections and serious toxic 
effects. A large number of new combina- 
tions has been introduced. Since none of the 
combinations has clearly shown any thera- 
peutic advantage over the proper use of the 
more effective component alone, the patient 
is unnecessarily placed in "double jeopar- 
dy" — of toxic reactions and of acquiring 
sensitization to both agents. 

Berntsen and McDermott'"" observed 
that the carrier rate among hospitalized 
patients receiving tetracyclines increased 
nearly threefold over the rate among hos- 
pitalized patients receiving no antibiotics. 
In addition, new strains were substituted 
for old among antibiotic treated patients at 
twice the rate observed in untreated pa- 
tients. 

On the basis of substantial evidence sug- 
gesting that multiple-resistant strains of 
Staph, aureus, hospital variety, are of en- 
hanced virulence, Barber and her colleagues 
at Hammersmith Hospital in London made 
a vigorous attempt to cut down the inci- 
dence of infection by these organisms 16 '. 
This effort was combined with strict appli- 
cation of various anti-cross-infection mea- 
sures that had been previously introduced, 
and featured : ( 1 ) marked restriction of 
the use of all antibiotics for prophylactic 
purposes; (2) strict limitation of the use 
of penicillin; (3) the general employment 
of double chemotherapy, each drug being 
used in full doses and only for definite in- 
dications. Under this policy a significant 
reduction of antibiotic-resistant infections 
occurred and concomitantly the number of 
infections sensitive to penicillin rose sharp- 
ly. 

It may be pointed out that agents like 
Kanamycin, vancomycin and ristocetin 
have had little tendency to produce resist- 



ance. Such resistance is difficult to produce 
in vitro. These antibiotics are given intra- 
venously, a limiting factor in their whole- 
sale use. 

Co)iclusion 

In general, when dealing with severe 
staphylococcic infections, a focus on target 
with a narrow spectrum antibiotic may 
bring best results. Success with ristocetin 
and vancomycin has been attributed to this 
factor. 

Awareness of the manifestations and 
gravity of staphylococcic pneumonia, with 
attention to early diagnosis and decisive 
therapy, both medical and surgical, is to be 
emphasized as essential for the successful 
management of this disease. 

Measures to lessen the incidence of staph- 
ylococcic infections have been effective 
when they have emphasized a return to 
principles of rigid asepsis, isolation of in- 
fected patients and judicious control and 
use of antibacterial agents. Recognition of 
the fact that the use of steroids and anti- I 
biotics may actually encourage invasion by 
staphylococci is essential. Observance of 
the foregoing measures may then go far 
toward suppressing, if not eradicating, 
these infections. 

References 

1. Calvy, G. L.: Stalking the Staphylococcus: New England H 
J. Med. 259:532-534 ( Sept. I 11) 1958. 

2. Schumacher. L. R.. Coates. J. R., Sowell, R. C. and 
Calvy, G. L.: Staphylococcal Pneumonia: A Clinical 
Evaluation of 40 Cases. Clin. Research 7:267 (April) 1959. 

3. Ede. S.. Davis. G. M.. and Holmes. F. H.: Staphylococcic 
Pneumonia. J.A.M.A. 170:638-643 lJune 6) 1969. 

4. Editorial: Antibiotics in Fixed Combinations. New Eng- 
land J. Med. 262:255-256 I Feb. 4 1 1960. 

5. Berntsen, C A., and McDermott. W.: Increased Trans- 
missibility of Staphylococci to Patients Receiving an 
Antimicrobial Drue. New England J. Med. 262:637-642 
(March 31) 1960. 

6. Barber, M.. and others: Reversal of Antibiotic Resistance 
in Hospital Staphylococcal Infections, Brit. M. J. 1:11-17 
(Jan.) 1960. 



July, 1960 



279 



Some Facts About Nursing in North Carolina 



Vivian M. Culver, R.N. 
Raleigh 



May I thank the program committee for 
the invitation to appear before this assem- 
bly today. I consider it a real privilege and 
an opportunity to share with you some in- 
formation regarding nursing and nursing 
education in this state. 

What I have to say about North Caro- 
lina's needs in nursing is not unique to this 
state, but this fact does not make our needs 
any more palatable. And what I have to say 
in relation to shortages of prepared people 
is not peculiar to nursing alone. We are 
experiencing a real lag in the preparation 
and retention of members in your group, in 
my group, and in other paramedical groups 
as well. You are as aware of these facts as 
I. 

In looking closely at nursing in North 
Carolina, I could quote all types of figures 
for you. But the fact remains that we are 
short of two things — nurses and nursing. 

The Shortage of Nurses 

Why are we short of nurses? Here are 
five principal reasons for this situation. 

1. We do not recruit enough capable 
young women — and men, too — into this 
field. Other areas of endeavor are earnestly 
competing for high school graduates. 

2. Out of the number we do recruit, the 
quality of the candidates yields about a 35 
to 40 per cent drop-out — not in all cases for 
scholastic reasons, but in the majority. Too 
many students can't read, write, and think 
productively. The course in nursing is 
rugged. And high school has never given 
them so much to do in so short a time. 

3. Then after completing the course, any- 
where from 25 to 35 per cent fail one or 
more of the five subjects in the licensure 
examination. 

4. Then after licensure we are constantly 
losing from two to three nurses to other 
states for every nurse who come here to 
work. 

5. And finally, no small factor in this 
problem is the number of nurses who are 
inactive in the profession. After a number 

Read before the Second General Session, Medical Society 
of the State of North Carolina, Raleigh, May 11, 1960. 

•Executive Secretary, North Carolina Board of Nurse Regis- 
tration and Nurse Education. 



of child-rearing years a large percentage 
come back. But presently there are over 
5,000 inactive nurses in North Carolina. 

I have enumerated five serious problems 
in relation to the short supply of nurses. 
There are others quite familiar to all of us. 

The Shortage of Nursing 

Next, let's look at the shortage of nurs- 
ing. Quite naturally a limited number of 
nurses yields less nursing. But that isn't 
the only limiting factor. 

Nursing is perhaps best described as the 
giving of direct assistance to a person, as 
required, because of the person's specific in- 
ability to care for himself for reasons of 
health 11 '. Self-care means the care which 
all persons require each day, and you well 
know what modifications are necessary dur- 
ing illness. 

Added responsibilities 

Our horizons in health care and medical 
management have expanded more in the 
last 25 to 30 years than in all previous his- 
tory combined. This lays tremendous re- 
sponsibility on your shoulders, not only in 
cure but in prevention and rehabilitation as 
well. The new techniques, methods, equip- 
ment, drugs, and treatments for that 30- 
year period would defy enumeration by 
anyone in this room today. You have asked 
my group to help carry some parts of your 
expanding responsibilities. We have tried — 
we are trying. Every task that you no 
longer have the time to do or that you feel 
is safe for one with less depth of medical 
understanding you quite naturally ask the 
nurse to do. Just two examples — very ele- 
mentary, yet significant: Within 60 years 
the thermometer has moved from the red 
plush box in your bag to every home and 
hospital. And in the last 30 years the 
sphygmomanometer has come to be used 
even by the practical nurse. 

Today we are struggling with the task 
of starting intravenous fluids — and trying 
to determine what safe steps can be taken 
to ensure better care of the "about to de- 
liver" mother — among a host of other shift- 
ing responsibilities. 



L'SII 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



Why do I mention shifting of some re- 
sponsibilities? First, because it is a natural 
development to a point; and next, because 
the greater the demands on the nurse to 
support the doctor in his plan of medical 
management, the less time she has to meet 
the needs of the patient which have no 
doctor's orders written for them. 

Complexity of organization 

Another factor in the shortage of nurs- 
ing is the highly complex organization of 
today's hospitals. Much nursing time is 
consumed in the mechanics of this organ- 
ized structure. Some say it is so highly 
structured that it is impersonal — and this 
fact is poorly understood by a sophisticated 
society. 

What happens to the person — the nurse 
who by the very elements of her employ- 
ment no longer has time to assist the pa- 
tient? In due time she is apt to be satisfied 
in managing, scheduling, ordering, and do- 
ing the highly technical things falling to 
her professional lot. If not, she is frus- 
trated, resigns, and tries to find some place 
where she can get back to the patient's side. 
Then she is accused by management of not 
wanting to take responsibility. I ask you — 
responsibility for what? The patient, yes, 
but management and direction of others, 
no. Many nurses do not want to be man- 
agers of nurses; they want to take care of 
patients. Our present structure inhibits this 
desire. 

No one factor is responsible for the 
shortage of nursing, as you can see. Many 
things are at work to bankrupt professional- 
ly the bedside nurse today. If there ever 
was a time when hospital administrators, 
doctors and nurses needed to look critically 
at how patients are getting hospital, med- 
ical, and nursing care, it was yesterday. 
This joint action is long overdue. 

Inadequacies in Nursing Education 

Nursing education in North Carolina is 
almost low man on the totem pole in this 
country. We have schools — we're eighth in 
the country in number. We have students — 
we're thirteenth in the country with them. 
T}|it Ayppn w e put our graduates against 
g raduates from other states on our licen - 
sing examination, we are well tnwarH t-Tjp 
bcfttenrr^l have sonle 1 -oplllloiis" as to why 
this is happening — some based upon fact 
1 and others upon feeling. Many of you have 



opinions too — likewise based upon fact and 
feeling. 

Quality of teaching 

One opinion I have is that the quality of 
teaching is below par. Why do I think so? 
Because 31 per cent of our teachers are not 
trained beyond their three-year diploma 
programs. They are not prepared as teach- 
ers. Teaching is itself a specialized art. 

I am not talking here about those few 
unique individuals among the 31 per cent 
who are naturals in the teaching role. I am 
concerned that too many of the remaining 
souls in that group are not giving the stu- 
dent a fair chance to learn nursing. It could 
and should be said that merely having a de- 
gree does not ensure that fair chance to 
learn, either. But if additional preparation 
means anything, it should provide a 
broader, deeper insight into the content to 
be taught, and effective ways to get it 
across. 

Along with our lag in preparation for 
teaching, we are short in numbers of 
teachers. As of March 30, 1960, 14.6 per 
cent of the teaching positions in diploma 
schools were unfilled. And the prospect is 
worse for fall. We do not have the teachers. 
These things I know to be facts. 

Content of teaching 

Now I have a feeling that part of our 
difficulty in our programs is what I call 
curriculum obesity and patient-practice 
starvation. When people in charge of 
schools do not know how to design and im- 
plement a curriculum, there is a great urge 
to add first one course and then another, 
thus thinking that they are keeping the pro- 
gram up to date. This is where the obesity 
sets in, and for every unneeded hour added 
to the classroom schedule we deny the stu- 
dent the opportunity of that hour to put into 
action some of her learning. What has hap- 
pened is that there is less and less time to 
teach and learn the art of meeting the needs 
of patients. 

In this process of addition we have not 
carefully scrutinized what we teach, nor 
have we done a good job of distilling those 
elements which have always been and will 
continue to be the essence of effective nurs- 
ing. We are trying — but it takes a qualified 
person to lead the faculty to such action. 
When such a person is lacking, a school 
rocks along, not knowing how to tighten up 



I 



I 






July, 1960 



NURSING IN NORTH CAROLINA— CULVER 



281 



the curriculum and put back into nursing 
those elements that have been crowded out. 
iWise choices must be made in selecting con- 
tent. If the essence of nursing has been re- 
placed with what appears to be more im- 
portant content, the faculty has some im- 
portant decisions to make. 

We need to help the student to learn to 
think through nursing situations— to draw 
I on her knowledge and develop judgment in 
carrying out her designated ministrations. 
Too often we fill the student with facts and 
then siphon them off in a test. Until these 
facts are put to practical use — until they 
are understood and translated into nursing 
care action — are they learned? 

I honestly believe that this is one impor- 
tant and significant reason why we have so 
many State Board failures. The questions 
are just not that difficult. They are thought- 
provoking — yes. They are situational — yes ; 
they draw upon knowledge — yes; and they 
ask for designated action, judgment, read- 
ing ability, familiarity with vocabulary, 
and reasoning ability. 

We have recently visited a state in the 
deep South to try to determine why their 
graduates pass State Boards and ours fare 
so poorly. One finding was that every school 
has some prepared faculty. They make it 
t heir business to teach less medicine and 
mo re nursing. They locus on trie p'allfelll 111 
their teaching and in the student's practice. 
' This we are beginning to do, too, but we are 
having a hard time shaking loose from the 
idea that the focus should not be on the dis- 
ease but on how to nurse the patient who 
has specific needs because he has a certain 
disease or deficiency. 

Need for a Joint Approach 

I will never have a better opportunity to 
thank you ladies and gentlemen for your 
continuing efforts and interest in nursing 
education in this state. We appreciate and 



need your contributions. We also need your 
continued understanding to help us with 
our boot strap operation. 

I would like to see North Carolina lead 
the nation in a joint study of this serious 
problem of shortage of nurses and nursing. 
I would like to see medicine, hospital ad- 
ministration, and nursing attack the prob- 
lem together. In some states the medical 
group appoints a committee, makes a study, 
and comes out with a report. Hospital ad- 
ministration agonizes over it and from time 
to time tries to solve the whole thing at a 
convention. This problem is much too com- 
plex for such atomistic attacks. It is serious 
enough to tax the combined effort of all 
concerned. North Carolina could make such 
an approach, and by so doing could set an 
example of the leadership so woefully 
needed today in arriving at solutions. 

We had some joint action in North Car- 
olina during the Good Health movement. 
The nation watched North Carolina at that 
time with great interest. A report was pub- 
lished in 1950 concerning our needs in 
nursing. We have not done much during 
this decade to come really to grips with 
those recommendations or to know whether 
they were realistic or attainable. Many of 
the recommendations are still unmet — and, 
I might say, unknown and forgotten. 

We must come to grips with what is 
realistic for us to do in North Carolina and 
what is unattainable. To do this we need 
facts — more facts with less emotionalism 
and I might even add less provincialism. 
This is a serious challenge. Until we meet 
it, hospital administrators, doctors, and 
nurses will continue to talk about this prob- 
lem in misty generalities. 

Reference 

1. Orem, D. E. : Guides for Developing Curricula for the 
Education of Practical Nurses. Washington. D.C., U. S. 
Department of Health. Education and Welfare, 1959. 



... it is necessary that both in schools and in universities we should 
rediscover the part played by leisure in education. There is a danger that 
we may so fill our pupils' lives, not only with specialist studies, not only 
with the process of overfrequent examining, but with general education 
and social activities as well, that they may never have time to read or 
talk or even simply to think what it is all about. — Sir Eric James, Brit. 
M.J. 2:576 (Sept. 6) 1958. 



L'SL' 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



A Rural Home Care Program 

O. David Garvin, M.D., M.P.H. 
Chapel Hill 



To tell you about the Rural Home Care 
Program now being carried on in Person 
County, North Carolina, I must tell you a 
little about the county. Person County is 
one of five counties making up the district 
of which I am director. It is located in the 
north central portion of the state and 
covers an area of 20 miles square, with one 
town, Roxboro — population 5,000. The total 
population of the county is 25,000 of whom 
about 40 per cent is non-white. It is one of 
the few counties that experienced a popu- 
lation loss between 1940 and 1950. This 
loss was attributed to the migration of able- 
bodied persons in search of work. These 
migrants leave their children behind in the 
care of grandparents, creating many prob- 
lems and difficult financial situations. 

Person County is primarily rural, deriv- 
ing its income chiefly from farm products 
(tobacco), with a few small manufacturing 
companies located around the town of Rox- 
boro. 

Person County has 11 practicing physi- 
cians — one retired for all practical pur- 
poses, two surgeons, one internist, and 
seven general practitioners, two of these 
being over 70 years of age. There is a good 
60-bed general hospital (constructed with 
Hill-Burton funds). The Health Depart- 
ment is housed in a new building. Within 
50 miles of Roxboro are four large medical 
centers. The working relationship within 
the county has been cooperative and har- 
monious. 

Tuberculosis Program Paves the Way 
When I came to Person County in 1944, I 
found a minimal tuberculosis program di- 
rected toward the far advanced cases be- 
cause of limited facilities and personnel. At 
that time, tuberculosis and venereal disease 
were the most pressing health problems in 
the county. As a result of improved medica- 
tion, refined diagnosis and techniques in 
health education, the venereal disease prob- 
lem has been brought under control. We 
have worked just as diligently on our tu- 
berculosis problem, with the result that 
our death rate from tuberculosis is virtual- 



Read before the Regional Conference on Aging, Atlanta, 
Georgia, March 7, I960. 



ly nil, while our case rate increases and our 
total number of cases under supervision 
multiplies. Last year our county had one of 
the highest case rates in the state. 

I emphasize the role of tuberculosis in 
our set-up because of its direct bearing on 
the present Home Care Program. Fifteen 
years ago when it became evident that 
many of our tuberculous patients were dy- 
ing at home while awaiting sanatorium ad- 
mission, a program of home care was a 
pressing necessity. At the suggestion of the 
County Medical Society, the County Board 
of Commissioners provided extra funds for 
hospitalization, employment of additional 
public health nurses, and purchase of equip- 
ment for the home care of the tuberculous. 
In this program, the Health Department 
played the major role by furnishing the 
x-ray facilities for screening, diagnosis, 
and follow-up, and I provided medical care 
within the home for patients who were 
under the supervision of the local doctors. 

This program was agreed on and devel- 
oped jointly by the Health Department, 
Medical Society, County Board of Commis- 
sioners, and other agencies both voluntary 
and official. At this particular time no 
young doctors were practicing within the 
county, and it was the wish of the local 
medical society that I provide the tubercu- 
losis treatment while they supervised the 
case and treated any complications or acute 
illnesses that occured. Later, the County 
Board of Commissioners provided funds 
for drug therapy for tuberculosis cases. 

As a result of the successful handling of 
the tuberculosis problem in the county and 
the harmonious cooperation of everyone 
concerned, it was no problem to secure sup- 
port for the expanded Home Care Program. 
In addition to our Tuberculosis Program, 
we were confronted with an aging popula- 
tion afflicted with so-called "chronic dis- 
ease." Throughout all these years of work, 
publicity was given the work being done 
and the needs existing within the county. 
All media were used to inform the county 
officials and the public of the needs of the 
county. 



July, 1960 



RURAL HOME CARE— GARVIN 



283 



Project Proposal Approved 

Several years ago the local, State and 
American Medical Associations, the local, 
State and National Public Health agencies, 
and officials at all levels of government be- 
gan to realize that a program for Home 
Care should be developed, and that it 
should not be restricted to urban areas but 
made available to all people. Until we un- 
dertook to provide home care in this rural 
area, no similar project had been developed. 
When it was suggested that support from 
official agencies, the Public Health Service, 
and the State Board of Health could be 
secured if the county would provide some 
funds for matching purposes, it was not 
difficult to secure the local support needed. 

In cooperation with the Person County 
Medical Society, the State Board of Health, 
and the U. S. Public Health Service, a pro- 
ject proposal was prepared and submitted. 
After the State Board of Health and the 
Public Health Service gave tentative ap- 
proval, the County Commissioners appro- 
priated a sum of money for matching pur- 
poses. Final approval was given the project 
and the following personnel were author- 
ized : a medical social worker, physical 
therapist, two public nurses, and one clerk. 
Also, funds for contractural purposes were 
made available. 

The tentative project proposal was not 
prepared or submitted until it had been 
discussed in detail with the local medical 
society, and a set of policy and procedure 
statements relating to every phase of the 
anticipated program had been developed. 
The local society agreed, without a single 
dissenting voice, to provide medical care 
and supervision for all persons residing 
within the county who were referred to and 
carried by the project. The purpose or ob- 
jectives are "To show how National, State 
and Local agencies, both official and non- 
official, can coordinate their efforts in a 
program for Home Care and restoration of 
the chronically ill in a rural area and to de- 
termine what personnel and funds are ne- 
cessary to provide for services aimed at 
self care or self support by the patients." 

At this time, it was agreed that the 
doctor-patient relationship would remain in 
effect at all times ; that the project would 
not accept patients referred by anyone 
other than the physician. The physician 
would continue to direct the care of the pa- 



tient at all times, the Health Department 
would provide services available through 
the staff, and no fee would be charged for 
services rendered by the staff of the Health 
Department. After the endorsement by the 
local medical society, the project proposal 
was submitted through official channels. 
Operation began officially when the phy- 
sical therapist reported for duty. The pro- 
ject is now operating with a full staff of 
qualified workers. 

Home-Care Integrated into Total 
Health Program 

We have endeavored to integrate this 
program into the over-all program of the 
Health Department and of the many other 
agencies providing health services in the 
community. The services available through 
the project are nursing, physical therapy, 
social service, occupational therapy, nutri- 
tional counseling, medicine and sick room 
supplies, orthopedic equipment, and health 
education. Every other community resource 
is brought to bear upon the patient's illness 
through the coordination of the Health De- 
partment. Lay committees organized dur- 
ing the planning stage are Health Educa- 
tion, Procurement and Supply, Vocational 
Rehabilitation, Social Service, and Chap- 
lain and Recreation. In addition, there is 
an advisory and technical committee made 
up of representatives from local and State 
medical societies, local and state welfare 
associations, State Nurses' Association, 
State Board of Health, and the University 
of North Carolina School of Public Health. 

All benefits to the individual patient in 
the program are the result of a concerted 
"team effort." The Health Department 
team teaches and provides services as 
ordered by the attending physician. The 
patient and his family are taught the pro- 
per care of the patient through the actual 
services of the physical therapist, the Pub- 
lic Health nurse, the medical social worker, 
and the nutritionist. Thus the private phy- 
sician and this team work as an effective 
unit toward the achievement of maximum 
recovery and physical independence of the 
patient. 

I spent much of the time alloted me in 
discussing the history of the Person Coun- 
ty Home Care Demonstration Project and 
the needs that brought it into being. This 
project was a natural outgrowth of com- 
munity recognition and interest. In fact, 






284 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



the medical society, county officials, and the 
public at large have cooperated in a man- 
ner that has been heartwarming to those of 
us who so often have seen this segment of 
our population cast into the role of the for- 
gotten man. This is a type of program that 
can be developed and operated in any rural 
area where there are an informed public, 
medical facilities, and an agency that can 
serve as coordinating agent. 

I want to restate the purpose of the pro- 
ject, "To demonstrate how Federal, State, 
and Local Official and non-official agencies 
in the community as individuals and as a 
whole can coordinate their efforts in an or- 
ganized program for the Home Care and 
Restoration of the chronically ill in a rural 
area. Further, to determine the number of 
people and the funds necessary to provide 
restoration services which aim at self-care 
and/or self-support of the patients." 

Aims and Achievements 
This home care program in Person Coun- 
ty has been in operation since September 
8, 1958. We think that the following results 
have been achieved : 

1. The first rural Home Care Project 
has been established. 

2. The project has been developed with- 
out serious conflicts of interest. 

3. It has had public acceptance. 

4. There has been a gradual build-up of 
patients admitted to the program. 

5. A harmonious working relationship 
with the doctors has been maintained. 

6. A physical therapy department has 
been prepared and equipped at the 
county hospital. 

7. The community has united to support 
and promote the project. 

8. The project has provided a health 
education topic. 

There have been problems as may be ex- 
pected with any new program; but these 
were chiefly associated with record devel- 
opment and recruitment of specialized per- 
sonnel. 

You might ask, "What are the antici- 
pated results?" I will list the major aims. 

1. To provide information about the 
cost of home care in a rural area. 

2. To shorten the period of hospital 
stay for patients with long-term ill- 
ness. 

3. To extend into the home services 
ordinarilv restricted to hospital. 



4. To reduce the number of people dis- 
abled by chronic conditions. 

5. To effect a reduction of cost to the 
county for hospital and welfare care 
for persons with long-term illness. 

6. To provide adequate medical care for 
the people of Person County. 

Analysis of Results 

Between September 8, 1958, and Decem- 
ber 31, 1959, 55 patients had been referred. 
Of these, 54 were admitted to the program 
and given service. Before a person is ac- 
cepted several things must be done: 

1. The patient is referred by a doctor, 
using a form developed by the team. 

2. Representatives of all disciplines 
visit and evaluate patient. 

3. An admission conference is held with 
the following in attendance: the phy- 
sician in charge of case, the medical 
social worker, the physical therapist, 
a Public Health nurse, and other in- 
terested persons. 

4. Patient must show potential for re- 
storation to self-help or employment. 

Up to the present time, 13 patients have 
been discharged (by conference similar to 
admission conferences) from the program, 
with 40 active at the present time and 1 
classed as inactive. Of the 13 discharged, 
2 achieved maximum benefits, 6 died, 3 
moved out of the county, and 2 were dis- 
charged for other reasons. Of the 40 given 
service, 29 were classed as active in the 
home, 5 as active out-patients, and 6 as ad- 
visory in the home. When the program be- 
gan, there were 3 chronically ill persons in 
the local hospital who had been there more 
than a year. Today 2 of these are at home 
and the third has died. One of the patients 
that we are caring for in the home today 
reportedly cost a hospital in a neighboring 
county $17,000 before discharge. 

You will recall that to date 6 patients 
have died. This mortality can be explained 
by the fact that the median age for patients 
accepted on the program is slightly more 
than 67 years. Of the total 45 given care 
during the past three months, 12 were 60 
to 69 years of age, 13 were 70 to 79, and 
4 were more than 80. 

Thirty-five of the patients were white 
and 10 were non-white, eighteen were male 
and 27 were female. The socioeconomic 
classification was as follows : high bracket, 



July, 1960 



RURAL HOME CARE— GARVIN 



285 



6; middle bracket, 16; low bracket, 10; 
Public Assistance recipients, 13. Please 
note that we do not deny admission to any- 
one because of financial status or race. 

Of the 45 patients handled during the 
past three months, primary diagnoses were 
as follows: cardiovascular accidents, 15; 
arthritis, 11; fractures, 9; neurologic dis- 
orders, 5 ; burns, 2 ; scoliosis, 1 ; multiple 
sclerosis, 1; muscular distrophy, 1. You 
might be surprised to learn that obesity 
was listed as the secondary diagnosis in 6 
cases ; arthritis in 5 ; high blood pressure in 
5; diabetes in 4. Many other conditions 
made up the remainder. 

To render the needed services to these 
patients, 36 admission conferences, 90 re- 
view conferences, and 4 discharge confer- 
ences have been held during the past year, 
for a total of 130. Visits made to patients 
by members of the health department team 
were 630 by public health nurses, 849 by 
the physical therapist, and 96 by the med- 
ical social worker. These figures may sound 
small, until it is remembered that we are 
working in a small county with a limited 
staff, limited financial resources, and that 
we have experienced difficulties in securing 
qualified personnel. 

I have said that the project would pro- 
vide care only for persons who will benefit 
and can be restored to self-care or self- 
support. The project itself does not provide 
for the admission of terminal care cases. 
Patients needing terminal care are ad- 
mitted to the general public health program 
and are serviced by the staff of the Health 
Department. 

Conclusioyi 
The people of Person County are proud 
of the fact that this is the first project of 
its kind to be carried on in a rural area in 
the United States. We are determined to 
make it work and to provide answers to the 
questions posed by those supporting the 
project. The questions are: 

1. What are the benefits derived from 
such a project? 

2. Are they too expensive? 

3. How can medical care of the chron- 
ically ill be financed best? 

We are convinced that the project and 
the Home Care Program provides aid and 
assistance to the general practitioner or lo- 
cal practitioner in the care of his patient 
in the county hospital and the home. 



SPECIAL REPORT 

Report on Actions of the House of Delegates 

American Medical Association 

One Hundred Ninth Annual Meeting 

June 13-17, 1960 

Miami Beach 

Health care for the aged, pharmaceutical 
issues, occupational health programs, rela- 
tions with allied health groups, and rela- 
tions with the National Foundation were 
among the major subjects involved in policy 
actions by the House of Delegates at the 
American Medical Association's One Hun- 
dred Ninth annual meeting held June 13-17 
in Miami Beach. 

Dr. Leonard W. Larson of Bismarck, 
North Dakota, former chairman of the 
A. M. A. Board of Trustees and of the 
A. M. A. Commission on Medical Care 
Plans, was named president-elect by unan- 
imous vote. Dr. Larson will succeed Dr. E. 
Vincent Askey of Los Angeles as president 
at the Association's annual meeting in 
June, 1961, at New York City. 

The A. M. A. 1960 Distinguished Service 
Award, one of medicine's highest honors, 
was given to Dr. Charles A. Doan, who will 
retire next year as dean of the Ohio State 
University College of Medicine and director 
of the Health Center in Columbus, Ohio. 

Total registration through Thursday, 
with half a day of the meeting still remain- 
ing, had reached 19,107, including 8,706 
physicians. 

Health Care For The Aged 

After considering a variety of reports, 
resolutions and comments on the subject of 
health care for the aged, the House of Dele- 
gates adopted the following statement as 
official policy of the American Medical As- 
sociation : 

Personal medical care is primarily the respon- 
sibility of the individual. When he is unable to 
provide this care for himself, the responsibility 
should properly pass to his family, the commun- 
ity, the county, the state, and only when all 
these fail, to the federal government, and then 
only in conjunction with the other levels of gov- 
ernment, in the above order. The determination 
of medical need should be made by a physician 
and the determinati"^ of eligibility should be 
made at the local levei .vi+h local administration 



This report was forwarded to the Journal by Dr. Klias 
Faison of Charlotte, Secretary of the North Carolina dele- 
gates to the A.M. A. 



286 



NORTH CAROLINA MEDICAL JOURNAL 



July, 196fl 



and control. The principle of freedom of choice 
should be preserved. The use of tax funds under 
the above conditions to pay for such care, 
whether through the purchase of health insur- 
ance or by direct payment, provided local op- 
tion is assured, is inherent in this concept and is 
not inconsistent with previous actions of the 
House of Delegates of the American Medical 
Association. 

The House also urged the Board of 
Trustees "to initiate a nonpartisan open 
assembly to which all interested represen- 
tative groups are invited for the purpose 
of developing the specifics of a sound ap- 
proach to the health service and facilities 
needed by the aged, and that thereafter the 
American Medical Association present its 
findings and positive principles to the peo- 
ple." 

In connection with an educational pro- 
gram regarding the aged, the House de- 
clared that "the American Medical Associa- 
tion increase its educational program re- 
garding employment of those over 65, em- 
phasizing voluntary, gradual and individual 
retirement, thereby giving these individuals 
not only the right to work but the right to 
live in a free society with dignity and 
pride." 

Earlier, at the opening session, Dr. Louis 
M. Orr, retiring A. M. A. president, had 
asked the House to go on record favoring 
more jobs for the aged, voluntary retire- 
ment and a campaign against discrimina- 
tion because of age, whether it be 40 or 65. 
The House also gave wholehearted approv- 
al to Dr. Askey's urging that state medical 
societies take an active part in state confer- 
ences and other planning activities preced- 
ing the January, 1961, White House Con- 
ference on Aging. 

Pharmaceutical Issues 

In the pharmaceutical area the House 
took two actions — one regarding mail order 
drug houses and the other involving the 
development and marketing of pharma- 
ceutical products. 

The House agreed with representatives 
of the pharmacy profession that the unor- 
thodox practice of mail order filling of pre- 
scription drugs is not in the best interest of 
the patient, except where unavoidable be- 
cause of geographic isolation of the patient. 
The statement pointed out that in this pro- 
cess the direct personal relationship, which 
exists between the patient-physician-phar- 



macist at the community level and which is 
essential to the public health and the wel- 
fare of patients, is lost. 

The House also directed the Board of 
Trustees to request the Council on Drugs 
and other appropriate Association councils 
and committees "to study the pharmaceu- 
tical field in its relationship to medicine and 
the public, to correlate available material, 
and after consultation with the several 
branches of clinical medicine, clinical re- 
search, and medical education and other in- 
terested groups or agencies, submit an ob- 
jective appraisal to the House of Delegates 
in June, 1961." The statement pointed out 
that certain proposals have been made 
which, if carried out, might impair the 
future of pharmaceutical research and de- 
velopment, thus retarding the progress of 
scientific therapy. It also said that the 
services of the pharmaceutical industry are 
so vital to the public and to the medical 
profession that an objective study should 
be made. 

Occupational Health Programs 

The House approved a revised statement 
on the "Scope, Objectives and Functions of 
Occupational Health Programs," which was 
originally adopted in June, 1957. The new 
statement contains no fundamental alter- 
ations in A. M. A. policy or ethical rela- 
tionships, but it adds important new ma- 
terial on the following points: 

1. Greater emphasis on the preventive 
and health maintenance concepts of oc- 
cupational health programs. 

2. A more positive statement of organ- 
ized medicine's obligation to provide 
leadership in improving occupational 
health services by part-time physicians 
in small industry. 

3. Increased emphasis on rehabilitation 
of the occupationally ill and injured. 

4. Inclusion of the proper use of immun- 
ization procedures for employes, as ap- 
proved by the House in 1959. 

5. A more adequate statement on the 
need for teamwork with lay industrial 
hygienists in tailoring each occupa- 
tional health program to the particular 
employe group involved. 

In approving the revised guides for oc- 
cupational health programs, the House also 
accepted a suggestion that the A. M. A. 
Council on Occupational Health undertake 






July, 1960 



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References: 1. Feinberg, S. M.J Feinberg, A. R., and Fisherman. 
E. W.: J. A.M. A. 167:58 (May 3) 1958. 2. Epstein. J. I., and Sher- 
wood. H. : Conn. Med. 22:822 (Dec.) 1958. 3. Friedlaender. S.. and 
Friedlaender. A. S. : Antibiotic Med. & Clin. Ther. 5:315 (May) 

1958. 4. Segal. M. S.. and Duvenci. J.: Bull. Tufts N.E. Medical 
Center 4:71 (April-June) 1958. 5. Segal. M. S. : Report to the 
A.M. A. Council on Drugs. J.A.M.A. 169:1063 (March 7) 1958. 

6. Hartung. E. F. : /. Florida Acad. Gen. Practice 8:18. 1957. 

7. Rein. C. R. ; Fleischwager. R., and Rosenthal. A. L. : J.A.M.A. 
165: 1821 (Dec. 7) 1957. 8. McGavack. T. H. : Clin. Med. (June! 

1959. 9. Freyberg, R. H. ; Berntsen, C. A., and Hellman. L. : 
Arthritis & Rheumatism 1:215 (June! 1958. 10. Hartung. E. F. : 
J.A.M.A. 167:973 (June 21) 1958. 11. Zuckner. J.; Ramsey. R. H.J 
Caciolo, C. and Gantner. G. E. : Ann. Rheumat. Dis. 17:398 (Dec.) 
1958. 12. Appel, B. ; Tye, M. J., and Leibsohn, E. : Antibiotic Med. 
& Clin. Ther. 5:716 (Dec.) 1958. 13. Kalz. F. : Canad. M.A.J. 
79:400 (Sept.) 1958. 14. Mullins, J. F.. and Wilson, C. J.: Texas J. 
Med. 54:648 (Sept.) 1958. 15. Shelley. W. B.; Harun. J. S.. and 
Pillsbury, D. M. : J.A.M.A. 167:959 (June 21) 1958. 16. DuBois. 
E. L. : J.A.M.A. 167:1590 (July 26) 1958. 17. McGavack. T. H.; 
Kao. K. T.; Leake, D. A.; Bauer, H. G., and Berger. H. E. : Am. 
J. M. Sc. 236:720 (Dec.) 1958. 18. Council on Drugs: J.A.M.A. 
169:257 (January) 1959. 



lid^u: 



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Concerning Your Health and Your Income 

A special report to members of the Medical Society of 

the State of North Carolina 

on. the progress of the Society's 

Special Group Accident and Health Plan 

in effect since 1940 

PROUDLY WE REPORT 1959 

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY. 

During the year we introduced a NEW and challenging form of disability protec- 
tion. There has been overwhelming response on the part of the membership. 

Participation in this Group Plan continues to grow at a fantastic rate. 

1960 

is our 20th year of service to the Society. It is our aim to continue to lead the field in pro- 
viding Society members with disability protection and claim services as modern as tomor- 
row. 

SPECIAL FEATURES ARE: 



1. Up to a possible 7 years for each sickness (no confinement required). 

2. Pays up to Lifetime for accident. 

3. New Maximum limit of $650.00 per month income while disabled. 

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health, are eligible to apply for the new and extensive protection against sickness and ac- 
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OPTIONAL HOSPITAL COVERAGE: Members under age 60 in good health may apply for 
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Write, or call us collect (Durham 2-5497) for assistance or information. 

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Professional Group Disability Division 
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July, 1960 



SPECIAL REPORT 



287 



a project to study and encourage the em- 
ployment of the physically handicapped. 

Allied Health Groups 

The House approved the final report of 
the Committee to Study the Relationships 
of Medicine with Allied Health Professions 
and Services and commended it as " a mon- 
umental work." The report covers the pre- 
sent situation, future implications and re- 
commendations, including guiding princi- 
ples and approaches to activate physician 
leadership. The House strongly recom- 
mended that A. M. A. activity in this vital- 
ly important area be continued, and it ap- 
proved the appointment of a Board of 
Trustees committee to carry on the work. 

To develop physician leadership in pro- 
moting cooperative efforts with allied 
health professions and services, the report 
suggested the following A. M. A. activities. 

1. A general conference should be held 
with allied scientists in the basic med- 
ical sciences and related disciplines for 
discussion of matters of common con- 
cern related to the creation of perma- 
nent, cooperative activities. 

2. Specific exploratory conferences should 
be held with members of segments of 
science allied to a given area of med- 
ical practice with the national medical 
organizations concerned. 

3. General and specific conferences should 
be held with professional and technical 
assistants on education, recruitment, 
and coordination of contributions. 

4. Through meetings and publications, 
reciprocal exchange of information 
should be provided between physicians 
and allied scientists and members of 
health professions. 

5. Effective, continuing liaison should be 
established between A. M. A. repre- 
sentatives and professional and tech- 
nical personnel. 

National Foundation 

The House took two actions involving re- 
lations between the medical profession and 
the National Foundation. It adopted a state- 
ment of policies for the guidance of state 
medical associations and recommended that 
they be adopted by all component medical 
societies. These policies cover such subjects 
as membership of medical advisory commit- 



tees, and basic principles concerning finan- 
cial assistance for medical care, payment 
for physicians' services and physicians' re- 
sponsibilities for constructive leadership in 
medical advisory activities. 

In another action the House directed the 
Board of Trustees to authorize further 
conferences with leaders in the National 
Foundation on the problem of poliomyelitis 
as it relates to the betterment of the public 
health and to consider further joint action 
toward the eradication of polio. The House 
commended the National Foundation for its 
outstanding service in the attack against 
polio, but pointed out that much work re- 
mains to be done in public education, vac- 
cination, continuing assistance for polio vic- 
tims, and research. 

Miscellaneous Actions 

In dealing with reports and resolutions 
on a wide variety of other subjects, the 
House also: 

Strongly reaffirmed its support of the 
Blue Shield concept in voluntary health in- 
surance and approved specific recommenda- 
tions concerning A. M. A. — Blue Shield re- 
lationships; 

Approved a contingent appointment of 
not more than six months for foreign med- 
ical school graduates who have been ac- 
cepted for the September, I960, qualifica- 
tion examination ; 

Agreed that the American Medical Asso- 
ciation should sponsor a second National 
Congress on prepaid health insurance; 

Approved a Board of Trustees request to 
the Postmaster General for a stamp com- 
memorating the Mayo Brothers; 

Decided that the establishment of a home 
for aged and retired physicians is not war- 
ranted at this time. 

Approved the establishment of a new 
"Scientific Achievement Award" to be 
given to a non-physician scientist on special 
occasions for outstanding work; 

Approved the following schedule for fu- 
ture annual meetings : Atlantic City, 1963 ; 
San Francisco, 1964, and New York City, 
1965; 

Approved the objectives of the A. M. A. 
Commission on the Cost of Medical Care 
established by the Board of Trustees and 
headed by Dr. Louis M. Orr, immediate 
past president of the Association ; 

Urged individual members of the Asso- 
ciation to take a greater interest and more 



288 



NORTH CAROLINA MEDICAL JOURNAL 



July. 19G0 



active part in public affairs on all levels; 

Reaffirmed its opposition to compulsory 
inclusion of physicians under Title II of 
the Social Security Act and recommended 
immediate action by all A. M. A. members 
who agree with that position ; 

Called for a review of existing and pro- 
posed legislation pertaining to food unci 
color additives, with the objection of sup- 
porting appropriate measures which are in 
the public interest; 

Urged reform of the federal tax struc- 
ture so as to return to the states and their 
political subdivisions, their traditional re- 
venue sources; 

Asked state and county medical societies 
to make greater use of A. M. A. recruit- 
ment materials in presenting medicine's 
story to the nation's high schools ; 

Requested the Board of Trustees to ini- 
tiate a study of present policy regarding 
the required content and method of prepar- 
ing hospital records; 

Commended the Department of Defense 
and the Air Force for establishing and op- 
erating the Aeromedical Transport Service 
and urged that it be maintained at optimum 
efficiency ; 

Directed the Board of Trustees to devel- 
op group annuity and group disability in- 
surance programs for Association mem- 
bers; and 

Expressed grave concern over the indis- 
criminate use of contact lenses. 

Addresses and Awards 

Dr. Orr, in his final report to the House 
at the opening session, urged medical so- 
cieties to "adopt" rural villages, cities, and 
regions in underdeveloped parts of the 
world and to send them medical, clinical, 
and hospital supplies. 

Dr. Askey, in his inaugural address 
Tuesday night, declared that medicine faces 
its greatest challenge in the decade ahead, 
adding that physicians must prove the ef- 
fectiveness of medicine practiced in a free 
society. Dr. John S. Millis (Ph.D.), presi- 
dent of Western Reserve University, Cleve- 
land, Ohio, and guest speaker at the in- 
augural ceremonies, said the human dilem- 
ma of the sixties is an increasing desire for 
security and authority with a diminishing 
desire for responsibility. 

At the Wednesday session of the House, 
Dr. Askey urged intensified, accelerated ef- 



fort in five areas — medical education, 
preparations for the White House Confer- 
ence on Aging next January, health insur- 
ance and third party relationships, mental 
health, and membership relations. 

The Goldberger Award in Nutrition was 
presented to Dr. Richard Vilter of the Uni- 
versity of Cincinnati. The Boy Scouts of 
America, celebrating its golden jubilee, 
presented the A. M. A. with a citation in 
appreciation of the medical profession's 
help and support. Dr. B. E. Pickett of Car- 
rizo Springs, Texas, retiring chairman of 
the Council on Constitution and Bylaws, 
received an award in recognition of his 
long service. 

Election of Officers 

In addition to Dr. Larson, the new pres- 
ident-elect, the following officers were 
named at the Thursday session : 

Dr. William F. Costello of Dover, N. J., 
vice president; Dr. Norman A. Welch of 
Boston, re-elected speaker of the House, 
and Dr. Milford 0. Rouse of Dallas, Texas, 
re-elected vice speaker. 

Dr. Gerald D. Dorman of New York City 
was elected to the Board of Trustees to suc- 
ceed Dr. Larson, and Dr. James Z. Appel of 
Lancaster, Pennsylvania, was re-elected to 
the Board. 

Elected to the Judicial Council, to suc- 
ceed Dr. Louis A. Buie of Rochester, 
Minnesota, was Dr. James H. Berge of 
Seattle. 

Named to the Council on Medical Educa- 
tion and Hospitals were Dr. William R. 
Willard of Lexington, Kentucky, succeed- 
ing Dr. James M. Faulkner of Cambridge, 
Massachusetts, and Dr. Harlan English of 
Danville, Illinois, who was re-elected. 

On the Council on Medical Service, the 
House re-elected Dr. Russell B. Roth of 
Erie, Pennsylvania, and Dr. Hoyt B. Wool- 
ley of Idaho Falls. 

Dr. George D. Johnson of Spartanburg, 
S. C, was named to succeed Dr. Pickett on 
the Council on Constitution and Bylaws. 

F. J. L. Blasingame, M.D. 
Executive Vice President 
American Medical Association 



July, 1960 



EDITORIALS 



289 



North Carolina Medical Journal 

Owned and published by 

The Medical Society of the State of North Carolina, 

under the direction of its Editorial Board. 

EDITORIAL BOARD 
Wingate M. Johnson, M.D., Winston-Salem 

Editor 
Miss Louise MacMillan, Winston-Salem 

Assistant Editor 
Mr. James T. Barnes, Raleigh 

Business Manager 
Ernest W. Furgurson, M.D., Plymouth 
John Borden Graham, M.D., Chapel Hill 
G. Westbrook Murphy, M.D., Asheville 
William M. Nicholson, M.D., Durham 
Robert W. Prichard, M.D., Winston-Salem 
Hubert A. Royster, M.D., Raleigh 

Address manuscripts and communications regarding 
editorial matter to the 
NORTH CAROLINA MEDICAL JOURNAL 
300 South Hawthorne Road, Winston-Salem 7, N. C. 
Questions relating to subscription rates, advertis- 
ing, ect., should be addressed to the Business 
Manager, 203 Capital Club Building, Raleigh, N. C. 
All advertisements are accepted subject to the ap- 
proval of a screening committee of the State 
Journal Advertising Bureau, 510 North Dearborn 
Street, Chicago 10, Illinois, and/or by a Committee 
of the Editorial Board of the North Carolina Medi- 
cal Journal in respect to strictly local advertising 
accepted for appearance in the North Carolina 
Medical Journal. 

Annual subscription, $5.00 Single copies, 75'' 

Publication office: Carmichael Printing Co., 1309 

Hawthorne Road, S.W., Winston-Salem 1, N. C. 

JULY, 1960 



THE A.M.A.'s ONE HUNDRED NINTH 
ANNUAL MEETING 

The actions of the A.M. A. House of Dele- 
gates are published elsewhere in this issue, 
so only a few random impressions will be 
given here. 

The total registration was 22,484, in- 
cluding 8,162 physicians. This was far be- 
low last year's Atlantic City mark of 32,882, 
including 13,143 physicians. Doubtless the 
strike of Eastern Airline pilots called just 
before the opening day of the meeting was 
partly responsible for this falling off in 
attendance. Without disparaging the hos- 
pitality of the Florida medical profession, 
however, it must be admitted that Miami 
Beach was far from an ideal convention 
site. The distance from the headquarters 
hotel, the Americana, to the exhibition hall 
was 7 miles and required 45 minutes or 
more on one of the buses provided for 
transportation. The section meetings were 
widely scattered, and many doctors were 
heard to express the same nostalgic feeling 



for Atlantic City that members of our State 
Society had expressed for Pinehurst. 

The scientific and technical exhibits were 
good, although not as well attended as they 
would have been in a more favorable loca- 
tion. Both Dr. Orr in his farewell address 
and Dr. Askey in his inaugural address 
did themselves proud. 

The election of Dr. Leonard Larson as 
president-elect met with universal approv- 
al. He has richly earned this honor and can 
be depended upon to carry on the good work 
of his predecessors. 

Our neighboring state, South Carolina, 
was well recognized. Dr. Julian Price of 
Florence was selected chairman of the 
Board of Trustees to succeed Dr. Larson. 
Dr. George Johnson of Spartanburg was 
elected to succeed Dr. B. E. Pickett of Texas 
as a member of the Council on Constitution 
and By-laws. Dr. Pickett was given a stand- 
ing ovation when he gave his final report 
as chairman of this important Council. 



THE OLD ORDER CHANGETH 
Dr. Alfred Potter's Presidential Address, 
delivered at the one hundredth forty-ninth 
Annual Meeting of the Rhode Island Med- 
ical Society and published in the June issue 
of the Rhode Island Medical Journal, is 
scholarly and thought-provoking. As the 
one hundredth president of the Rhode 
Island Society, Dr. Potter noted some of the 
most important changes in medical prac- 
tice that have occurred in the society's his- 
tory. 

He began by citing the record from the 
Providence Lying-in Hospital of a patient 
delivered by the matron. Since, fortunately 
for the patient, "Because of the Sunday 
horsecar delay the doctor was not present 
. . . The patient's course was remarkable in 
that at no time had the temperature risen 
above 100." At that time the words of 
Holmes and Semmelweiss had fallen on 
deaf ears. 

Dr. Potter commented that the economics 
of medicine had changed as much as our 
mode of transportation and our therapy. 
More and more people depend on insurance, 
and the depression era 5 to 1 ratio of serv- 
ice to private patient has been reversed. 
With the great increase in insurance, fees 
for medical service are being standardized. 
Dr. Potter deplores "the leveling of all 
doctors to a median payment" as "leading 



290 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



only to a dead level of mediocrity." He 
equally deplores, however, overcharging pa- 
tients, and is concerned because "it seems 
that of late years more persons than form- 
erly have entered medicine for financial 
betterment or for status." 

Two paragraphs deserve quoting in full: 

The infrequent overcharging or other wrong- 
doing in the way of unprofessional conduct by 
a few brings discredit on all. To minimize this 
situation we must be more than ever alert to 
police our own profession. The general public 
seems ready to believe the worst of us, 
without waiting to have the evidence presented 
and proved. From the very nature of our calling, 
the fact that we are usually employed only at a 
time of illness, suffering, anxiety, or grief, all 
unpleasant emotions, makes us by association the 
objects of unconscious disapproval and hostility. 
Enricus Cordus expressed this common feeling 
as far back as 1535 in these lines: 

"Three faces wears the doctor; when first 

sought, 
An Angel's, . . . And a God's the cure half 

wrought ; 
But when the cure complete, he seeks his 

fee, 
The Devil looks less terrible than he." 

I believe that a large part of the hostility 
toward medicine, outspoken by labor leaders, and 
rampant in many newspapers, is based on envy; 
envy of the doctor's independence. "We few, we 
happy few, we band of brothers" are of the few 
remaining self-employed. We are not retired at 
an arbitrarily fixed age while still fully or even 
better able to continue working. We may work 
as long and as many hours as we want or as our 
health permits. Having proved our competence 
to practice we are not displaced by changing 
production methods or economic upheavals. We 
have security, but only if we keep our health 
and maintain and enlarge our skills with new- 
knowledge. In a way we live dangerously, with 
no pension plans paid for by an employer. But 
we are our own masters, and I believe that for 
this reason we are envied by our detractors. At 
the same time, it is important to remember that 
this freedom carries with it great responsibil- 
ties. 

Dr. Potter found some comfort, after he 
had almost finished writing his address, 
from reading in the 1912 Presidential Ad- 
dress of Dr. Frederick Rogers : 

"How shall we regain the respect, the 
feeling- of security and confidence in the 
medical profession which was such a strong 
factor in human life a hundred years ago, 
but which now is unfortunately lacking?" 



And it is quite likely that a hundred 
years before Dr. Rogers asked this ques- 
tion, the more sensitive and intelligent 
leaders of the profession were still smart- 
ing from the caricature of doctors found in 
Moliere's writings and in Hogarth's paint- 
ings. Now, as then, our profession's most 
effective public relations can, in Dr. Pot- 
ter's concluding words, "best be regained 
and maintained by our individual and per- 
sonal contacts with our patients and other 
laymen." 



"SYMPTOMATIC MEDICINE" 

"Symptomatic medicine" has acquired 
the reputation of poor medicine, of the dis- 
pensing of a series of pills to relieve a suc- 
cession complaints in a patient with an 
undiagnosed or incurable illness. It is gen- 
erally referred to apologetically by the doc- 
tor in charge of the case, or condescending- 
ly or scathingly by another doctor review- 
ing the case. Is such an attitude justified? 
Why should not the patient's symptoms be 
relieved? 

The present century, because of the as- 
tounding advances in diagnostic techniques 
and in surgical and pharmacologic methods 
of cure, has witnessed a change in the goal 
of the medical profession. Cure of the dis- 
ease, or, if that is not possible, restoration 
of maximum function is now the aim, 
rather than alleviation of suffering while 
the disease runs its course in the patient. 
It is true that if the disease is properly 
diagnosed, and if a specific remedy is avail- 
able and properly prescribed, then the 
symptoms caused by the disease will abate 
and eventually disappear as the disease is 
healed, and a change in the symptoms may 
be a useful gauge of the progress of the 
treatment. 

But what of the many symptoms caused 
by "stress" or "tensions" or by unknown 
disorders? The patient may obtain some re- 
lief by learning that his headache is caused 
by tension or sinusitis rather than the 
brain tumor he feared, but he will still ex- 
pect some more direct relief while awaiting 
the benefits of measures directed toward 
the underlying condition. If such relief is 
not forthcoming, the less tolerant or less 
patient patient will seek help elsewhere — 

Reprinted from the Journal of the Florida Medical Asso- 
ciation 46:1262-1253 (April) 1960. 



July, 1960 



EDITORIALS 



291 



which explains why the quack and cultist 
still flourish in this age of medical miracles. 

One other point should be made. It is 
often thought that "symptomatic medicine" 
is easy — that the relief of a symptom in- 
volves a thorough grounding not only in 
physiology but also in the psychology of the 
doctor as well as the patient, and prescrib- 
ing for the symptoms presupposes an up to 
date knowledge of pharmacology. 

The relief of symptoms is still the prin- 
cipal desire of patients coming to the phy- 
sician. There should be no shame or stigma 
attached to granting such relief, provided 
the cause of the symptoms is understood. 
For a remarkably lucid and complete ex- 
position on this subject the interested read- 
er is referred to Dr. Walter ModelPs mon- 
ograph.' 1 * 

1. Modell, Walter: The Relief of Symptoms, Philadelphia, 
W. B. Saunders Company, 1955. 



NURSES AND NURSING 

No doubt many doctors will say a hearty 
"Amen" to Miss Vivian Culver's paper in 
this issue of the Journal. Many nurses, also, 
have been concerned about the trend in 
nursing education to emphasize the theory 
of nursing at the expense of patient care. 
As Miss Culver expressed it, we are short 
of both nurses and nursing. 

It is true that more and more nurses are 
expected to carry out procedures formerly 
done only by doctors — such as taking blood 
pressures. Parenthetically, this plan has the 
great advantage that nursing ministrations 
are so taken for granted by the average pa- 
tient that almost as a rule the pressures 
taken by the nurse are lower than those 
taken by the doctor. 

There has been a regrettable tendency to 
exalt the administrative role of the nurse 
at the expense of the active nursing care of 
the patient. Both types of nurses are 
needed, and both are important. The nurse 
who really enjoys patient care, however, 
should not be made to feel inferior to the 
supervisor type. 

What the late Francis Peabody said of 
the medical practice applies equally well to 
nursing: "The secret of the care of the pa- 
tient is caring for the patient." 



MEDICAL PREPAYMENT AND 
OUR SOCIAL PHILOSOPHY 

"A curious paradox of some contem- 
porary social philosophy is the idea that 
man should spend what he earns for his 
pleasures rather than for what he needs. 
It is appropriate, so this reasoning goes, 
that he should buy a television set, a vaca- 
tion in Florida or an outboard motor boat, 
because there are cardinal rights. But for 
something that he really needs, such as his 
life or his health, or the life of his child, 
someone else should pay. This may be the 
Government, his employer, his union, his 
great-aunt or anyone else who can be ca- 
joled or coerced into paying the price for 
him. If no one else will pay for it, the 
doctor should serve him for nothing." 

This observation by Dr. C. Marshall Lee, 
Jr., 111 raises a question of crucial impor- 
tance not only to the medical economy but 
to the whole pattern of our American so- 
ciety. 

For, as Dr. Lee puts it, the attitude he 
describes "may be acceptable for the child 
of an indulgent parent, but it is not appro- 
priate for a free man in a free society." 

What can the doctor do to counteract 
this philosophy and to forestall the social- 
ization of medicine which may be its ulti- 
mate product? 

First, the doctor should learn all he can 
learn about our voluntary medical prepay- 
ment programs. Physicians should recog- 
nize that, in Dr. Lee's words, "Far from 
being the meddlesome 'third party' for 
which they have an uneasy fear, (the pre- 
payment program) stands with them in the 
common effort to preserve a cherished 
concept of freedom." 

Secondly, the doctors — and only he — can 
make these programs operate to the satis- 
faction of the patient. Only he can see to it 
that the subscriber gets full value for the 
premium dollar he has invested in our vol- 
untary medical care program. 

Finally, the medical profession's own 
sponsored Blue Shield Plans offer the 
American doctor an opportunity not only 
to strengthen and confirm his patient's 
confidence in our traditional way of prac- 
ticing medicine, but also to participate 
actively in guiding the destiny of our med- 
ical prepayment program in the days ahead. 



292 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



CORRESPONDENCE 
To the Editor: 

Recently I received from the Board of 
Medical Examiners of the State of North 
Carolina a pamphlet listing the registered 
physicians in the state of North Carolina. 
Although I did not count the exact number 
registered I estimated that approximately 
five thousand physicians were registered in 
this pamphlet. It appears that the intake 
from this project is amounting to over $25 
thousand. 

In the foreword in this pamphlet the 
Board of Medical Examiners of the State 
are nice enough to give an exact copy of the 
law wherein this taxation is ordered. How- 
ever, I do not read in the law as published 
any direction wherein money will be spent 
from this collection to publish and mail out 
a pamphlet such as I have received. As I 
am a member of the North Carolina Med- 
ical Society I find that the roster which is 
published by the Society is much more con- 
venient and comprehensive as to the infor- 
mation on doctors in North Carolina. In 
fact, the pamphlet as put out by the Board 
of Medical Examiners is grossly lacking in 
the information and consequently will serve 
no purpose due to the fact that the roster 
published by the Medical Society is better. 

How many years will the physicians of 
North Carolina have to be bled for $25 
thousand or more every two years for them 
to finally realize that this is just another 
unnecessary taxation placed upon them? 

I sincerely hope that you will take some 
steps to bring this matter before the mem- 



bership of the North Carolina Medical So- 
ciety in an effort to get them to voice their 
feeling on this taxation and to take a firm 
stand on its approval or disapproval. If the 
consensus is toward approval then it should 
be so stated. If the voice is for disapproval 
then I think the Medical Society JOURNAL 
should be the place for the beginning of a 
campaign to have this law removed with all 
expediency. 

The internal revenue department knows 
the physicians of the state, the military 
knows the names of the physicians it may 
need, the North Carolina Medical Society 
has a roster of its members, the North 
Carolina Board of Medical Examiners now 
have a complete list of the physicians of 
the state, so now, who can defend the per- 
petuation of this unfair and unnecessary 
piece of legislation? 

J. R. Gamble, Jr., M.D. 

Lincolnton 

Note : The Biennual Registration Act 
was recommended after long deliberation 
by the Board of Medical Examiners, and 
adopted by a large majority of the dele- 
gates at its 1956 meeting. The reasons for 
it were given by Dr. Combs in a guest edi- 
torial in the December, 1957, issue. Since 
the North Carolina Medical Journal is 
the official organ of the North Carolina 
Medical Society, it would not be consistent 
for it to lead a crusade against a policy ap- 
proved by a majority of our House of Dele- 
gates. The columns of the Journal, how- 
ever, are open to any members who wish to 
give their views on this or any other action 
of the Society. — Ed. 



• •••a a Greensboro 




• »0 Raleigh 



Washington # Q t~fi 




MATERNAL DEATHS REPORTED IN NORTH CAR0L1NA\ / 

SINCE JANUARY I, I960 \ W "^. n9,on n - 




Each dot represents one death 



July, 19G0 



293 



Committees and Organizations 

SCHEDULE OF COMMITTEE AND 
COMMISSION APPOINTMENTS, 1960-1961 

NOTE: The Committees listed herein have been authorized by President Amos N. Johnson, 
and/or are required under the Constitution and By-Laws. 

Particular note should be taken of the authorization of the House of Delegates of 
a Commission form of organizational activity and that all Committees, excepting Com- 
mittee on Nomination, Committee on Negotiation, and Committee on Grievances, are seg- 
regated under the respective Commission in which the function of the committee log- 
ically rests. This will tend to eliminate overlapping and duplication in activity programs 
and result in coordination of the work of the Society in a manner to lessen the work of 
the delegates in the Annual Meeting of the House of Delegates. 

(The President, Secretary and Executive Director of the Society are ex-officio 
members of all committees and, along with the Commission Chairman, should receive no- 
tice of meetings, agenda and minutes of committee meetings during the activity year.) 



I. ADMINISTRATION COMMISSION 

Wayne J. Benton, M.D., Chairman 

2320 Battleground Rd. Committee 

Greensboro, North Carolina listing 

1. Finance, Committee on (1-1) #19 

Wavne J. Benton, M.D., Chairman 
2320 Battleground Rd. 
Greensboro, North Carolina. 

2. Liaison to Study Integration of Negro #44 
Physicians into Medical Society of State of 
North Carolina 

J. Street Brewer, M.D., Chairman 

P.O. Box 98 

Roseboro, North Carolina 

II. ADVISORY AND STUDY COMMISSION 

Jacob H. Shuford, M.D., Chairman 
7 Main Avenue Place, S. W. 
Hickory, North Carolina 

1. Auxiliary Advisory and Archives of Medical 
Society History, Committee on, (II-l) #1 

Roscoe D. McMillan, M.D., Chairman 

P. O. Box 232 

Red Springs, North Carolina 

2. American Medical Education Foundation, 
Committee on, (II-2) #2 

Ralph B. Garrison, M.D., Chairman 
222 N. Main Street 
Hamlet, North Carolina 

3. Blue Shield, Committee on (II-3) #8 
Jacob H. Shuford, M.D., Chairman 

7 Main Avenue Place, S. W. 
Hickory, North Carolina 

4. Constitution and By-Laws, 

Committee on, (II-4) #13 

Roscoe D. McMillan, M.D., Chairman 

Box 232 

Red Springs, North Carolina 

5. Credit Bureau, 

Committee on Medical, (II-5) #14 

W. Howard Wilson, M.D., Chairman 
403 Professional Building 
Raleigh, North Carolina 

6. Industrial Commission of North Carolina 
Committee to Work with, (II-6) #23 
Thomas B. Dameron, Jr., M.D., Chairman 
1313 Daniels Street 

Raleigh, North Carolina 

7. Medical Care of Dependents of Members of 
Armed Forces, (MEDICARE) 
Committee on, (II-7) #28 
David M. Cogdell, M.D., Chairman 

911 Hay Street 
Fayetteville, North Carolina 



8. Student A.M.A. Chapters, 

Committee Advisory to, (II-8) #41 

John P. Davis, M.D., Chairman 
821 Nissen Building 
Winston-Salem, North Carolina 

III. ANNUAL CONVENTION COMMISSION 

R. Beverly Raney, M.D., Chairman 
North Carolina Memorial Hospital 
Chapel Hill, North Carolina 

1. Arrangements, (of Facilities Annual 
Session), Committee on, (III-l) #4 
John S. Rhodes, M.D., Chairman 

700 West Morgan Street 
Raleigh, North Carolina 

2. Audio-Visual Scientific Postgraduate 
Instruction, Committee on, (III-2) #5 
J. Leonard Goldner, M.D., Chairman 

Duke Hospital 

Durham, North Carolina 

3. Awards, Committee on, (III-3) #6 
To be announced in Fall 

4. Delegates, Committee on Credentials 

to House of Delegates (III-4) #15 

T. Tilghman Herring, M.D., Chairman 
Wilson Clinic 
Wilson, North Carolina 

5. Exhibits, Committee on Scientific, 

(III-5) #17 

Raphael W. Coonrad, M.D., Chairman 
Broad & Englewood 
Durham, North Carolina 

6. Golf Tournament, Committee on 

Medical (III-6) #21 

Wm. A. Brewton, M.D., Chairman 

5 Lake Dr. 

Enka, North Carolina 

7. Scientific Works, Committee on (III-7) #7 
Wm. McN. Nicholson, M.D., Chairman 
Duke Hospital 

Durham, North Carolina 

IV. PROFESSIONAL SERVICE COMMISSION 

George W. Paschal, Jr., M.D., Chairman 
1110 Wake Forest Rd. 
Raleigh, North Carolina 

1. Emergency Medical and Military Service 
Committee on (IV-1) #16 
George W Paschal, Jr., M.D., Chairman 
1110 Wake Forest Rd. 

Raleigh, North Carolina 

2. Eye Care and Eye Bank, 

Committee on (IV-2) #18 

George T. Noel, M.D., Chairman 
211 Raleigh Building 
Kannapolis, North Carolina 



294 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



3. Insurances, Committee on, (IV-3) #24 

Joseph W. Hooper, Jr., M.D., Chairman 
410 North 11th Street 
Wilmington, North Carolina 

4. Necrology, Committee on, (IV-4) #30 
Charles H. Pugh, M.D., Chairman 

Box 527 

Gastonia, North Carolina 

5. Nursing, Committee of Physicians on, 
(IV-5) #33 
Robert R. Cadmus, M.D., Chairman 

N. C. Memorial Hospital 
Chapel Hill, North Carolina 

6. Postgraduate Medical Study, 

Committee on (IV-6) #35 

Samuel L. Parker, Jr., M.D., Chairman 
Kinston Clinic 
Kinston, North Carolina 

V. PUBLIC RELATIONS COMMISSION 

Hubert Mc.N. Poteat, Jr., M.D., Chairman 
713 Wilkins Street 
Smithfield, North Carolina 

1. Hospital and Professional Relations and 
Liaison to North Carolina Hospital 
Association, Committee on (V-l) #22 
Theodore H. Mees, M.D., Chairman 

501 West 27th Street 
Lumberton, North Carolina 

2. Legislation, Committee on, (V-2) #25 
Hubert McN. Poteat, Jr., M.D., Chairman 
713 Wilkins Street 

Smithfield, North Carolina 

3. Medical-Legal Committee (V-3) #27 
Julius A. Howell, M.D., Chairman 
Bowman Gray School of Medicine 
Winston-Salem, North Carolina 

4. Public Relations, Committee on (V-4) #37 
Edgar T. Beddingfield, Jr., M.D., Chairman 
P. O. Box 137 

Stantonsburg, North Carolina 

5. Rural Health and General Practitioner 
Award, Committee on (V-5) #39 
R. Vernon Jeter, M.D., Chairman 
Plymouth Clinic 

Plymouth, North Carolina 

6. Insurance Industry Liaison Committee #43 
Frank W Jones, M.D., Chairman 
Catawba Hospital 

Newton, North Carolina 

VI. PUBLIC SERVICE COMMISSION 

John R. Kernodle, M.D., Chairman 
Kernodle Clinic 
Burlington, North Carolina 

1. Anesthesia Study, Committee on, (VI-1) #3 
David A. Davis, M.D., Chairman 

North Carolina Memorial Hospital 
Chapel Hill, North Carolina 

2. Board of Public Welfare of North Carolina, 
Committee Advisory to, (VI-2) #9 
J. Street Brewer, M.D., Chairman 

P. O. Box 98 

Roseboro, North Carolina 

3. Cancer, Committee on, (VI-3) #10 
James F. Marshall, M.D., Chairman 

310 West 4th Street 
Winston-Salem, North Carolina 

4. Child Health, Committee on, (VI-4) #11 
Angus M. McBrvde, M.D., Chairman 

809 West Chapel Hill Street 
Durham, North Carolina 

5. Chronic Illness, Tuberculosis and Heart 
Disease, Committee on, (VI-5) #12 
John R. Kernodle, M.D., Chairman 
Kernodle Clinic 

Burlington, North Carolina 



5. Maternal Health, Committee on, (VI-6) #26 
James F. Donnelly, M.D., Chairman 
State Board of Health 
Raleigh, North Carolina 

7. Mental Health, Committee on, (VI-7) #29 
AUvn B. Choate, Ai.U., Chairman 

1012 Kings Drive 
Charlotte, North Carolina 

8. Occupational Health, Committee on, 

(VI-8) #34 

Hurry L. Johnson, M.D., Chairman 

P. O. Box 530 

Elkin, North Carolina 

9. Poliomyelitis, Committee on, (VI-9) #3fi 
Samuel F. Ravenel, M.D., Chairman 

104 E. Northwood Street 
Greensboro, North Carolina 

10. Rehabilitation Physical, 

Committee on (VI-10) #38 

George W. Holmes, M.D., Chairman 
2240 Cloverdale Avenue 
Winston-Salem, North Carolina 

11. School Health, Committee on, (VI-11) #40 
Irma C. Henderson Smathers, M.D., 

Chairman 
1295 Merrimon Avenue 
Asheville, North Carolina 

12. Veterans Affairs, Committee on, (VI-12) #42 
Samuel L. Elfmon, M.D., Chairman 

225 Green Street 
Fayetteville, North Carolina 

VII. NOMINATIONS, COMMITTEE ON (not 
commission constitutionally provided) #32 

Jacob H. Shuford, M.D., Chairman 
7 Main Ave. Place, S.W. 
Hickory, North Carolina 

VIII. GRIEVANCES, COMMITTEE ON, (not a 
commission By-Law provided) #20 

James P. Rousseau, M.D., Chairman 
1014 W. Fifth Street 
Winston-Salem, North Carolina 

IX. NEGOTIATIONS, COMMITTEE ON, (not a 
commission By-Law provided) #31 
Wm. F. Hollister, M.D., Chairman 

Moore County Hospital 
Pinehurst, North Carolina 
1. Committee Advisory to the Auxiliary and 

Archives of Medical Society History (14} II-l 
Roscoe D. McMillan, M.D., Chairman, Box 

232, Red Springs 
Ethel May Brownsberger, M.D., 75 Hender- 

sonville Road, Biltmore 
Warner L. Wells, M.D., Consultant, N. C. 

Memorial Hospital, Chapel Hill 
Coy C. Carpenter, M.D., Consultant, Bowman 

Gray, Winston-Salem 
Wilburt C. Davison, M.D., Consultant, 

Roaring Gap 
Joseph M. Hitch, M.D., 415 Professional 

Bldg., Raleigh 
Wingate M. Johnson, M.D., 300 S. Hawthorne 

Road, Winston-Salem 
Rose Pully. M.D., 1007^ N. College Street. 

Kinston 
Ivan M. Procter, M.D., 209 Hillcrest Road, 

Raleigh 
Jean Bailey Brooks, M.D , 1100 N. Elm 

Street, Greensboro 
James P. Rousseau, M.D., 1014 West Fifth 

Street, Winston-Salem 
Ben F. Royal, M.D., 900 Shepherd Street, 

Morehead City 



James Tidier, M.D., 

mington 
Paul F. Whitaker, 

Street, Kinston 



1010 Grace Street, Wil- 
M.D., 1205 N. Queen 



July, 1960 



SCHEDULE OF COMMITTEE APPOINTMENTS 



295 



Committee on American Medical Education 
Foundation (AMEF) (7) II-2 

Ralph B. Garrison, M.D., Chairman, 222 N. 
Main Street, Hamlet 

Wm. LeRoy Fleming, M.D., UNC School of 
Medicine, Chapel Hill 

J. Bivins Helms, M.D., Box 24, Morganton 

Harry L. Johnson, M.D., Box 530, Elkin 

Paul F. Maness, M.D., 328 W. Davis Street, 
Burlington 

Manson Meads, M.D., Bowman Gray, Win- 
ston-Salem 

Wm. Pettway Peete, M.D., Duke Hospital, 
Durham 

Committee on Anesthesia Study Commission 
(11) VI-1 

David A. Davis, M.D., Chairman, N. C. Mem- 
orial Hospital, Chapel Hill 

Beverly W. Armstrong, M.D., 106 W. 7th 
Street, Charlotte 2 

John R. Ashe, Jr., M.D., 624-A. N. Church 
Street, Concord 

Horace M. Baker, Jr., M.D., Medical Arts 
Building, Lumberton 

Samuel R. Cozart, M.D., 122 S. Green Street, 
Greensboro 

D. LeRoy Crandell, M.D., Bowman Gray, 
Winston-Salem 

Joseph S. Hiatt, Jr., M.D., 208 S. W. Broad 
Street, Southern Pines 

John R. Hoskins, III, M.D., 203 Doctors 
Bldg., Asheville 

Will Camp Sealy, M.D., Duke Hospital, Dur- 
ham 

Charles R. Stephen, M.D., Box 3535, Duke 
Hospital, Durham 

Thomas B. Wilson, M.D., Rex Hospital 
Laboratory, Raleigh 

Committee on Arrangements (3) — (plus 3 
consultants) III-l 

John S. Rhodes, M.D., Chairman, 700 W. 
Morgan Street, Raleigh 

Theodore S. Raiford, M.D., 301 Doctors Bldg., 
Asheville 

Walter Spaeth, M.D., 116 South Road Street, 
Elizabeth City 

George Gilbert, M.D., Consultant, 309 Doc- 
tors Bldg., Asheville 

Robert S. Roberson, M.D., Consultant, 102 
Brown Avenue, Hazelwood 

Jack C. Homer, M.D., Consultant, 119 Hos- 
pital Drive, Spruce Pine 

Committee on Scientific Audio-Visual 

Postgraduate Instruction (10) III-2 

J. Leonard Goldner, M.D., Chairman, Duke 
Hospital, Durham 

Lenox D. Baker, M.D., Duke Hospital, Dur- 
ham 

H. Frank Starr, M.D., Pilot Life Insurance 
Company, Greensboro 

Gordon M. Carver, Jr., M.D., 1203 Broad 

Street, Durham 

Joseph F. McGowan, M.D., 200 New Medical 
Bldg., Asheville 

C. Glenn Sawyer, M.D., Bowman Gray, Win- 
ston-Salem 

L. Everett Sawyer, M.D., 104 W. Colonial 
Avenue, Elizabeth City 

J. O. Williams. M.D., Cabarrus Memorial Hos- 
pital, Concord 

George T. Wolff, M.D., Co-Chairman, 135 
Bishop Street, Greensboro 

Warner L. Wells, M.D., N. C. Memorial Hos- 
pital, Chapel Hill 

Committee on Scientific Awards (10) II 1-3 
(to be announced in Fall) 



9. 



Committee on Scientific Works (III-7) (5)- 
(plus Section Chairmen as Consultants) 

Wm. McN. Nicholson, M.D., Chairman, Duke 
Hospital, Durham 

Hubert McN. Poteat, Jr., M.D., 713 Wilkins 
Street, Smithfield 

Paul F. Maness, M.D., 328 W. Davis Street, 
Burlington 

George M. Cooper, Jr., M.D., 2111 Clark 
Avenue, Raleigh 

George T. Wolff, M.D., 135 Bishop Street, 
Greensboro 

Consultants: (1960-1961 Section Chairmen) 

Julius Sader, M.D. (Gen. Practice of Medi- 
cine), 205 East Main Street, Brevard 

Walter Spaeth, M.D. (Internal Medicine), 116 
South Road Street, Elizabeth City 

Charles W. Tillett, M.D., (Ophthal & Otol), 
1511 Scott Avenue, Charlotte 

James E. Davis, M.D. (Surgery), 1200 Broad 
Street, Durham 

Wm. W. Farley, M.D. (Pediatrics), 903 W. 
Peace Street, Raleigh 

Fleming Fuller, M.D., (Ob-Gyn), Kinston 
Clinic, Kinston 

Isa C. Grant, M.D. (Pub Health & Ed), 3006 
Warren Ave., Raleigh 

Myron G. Sandifer, M.D. (N&P), N. C. 
Memorial Hospital, Chapel Hill 

Roger W. Morrison, M.D. (Pathology), 65 
Sunset Parkway, Asheville 

Charles E. Whitcher, M.D. (Anesthesia), 
300 Hawthorne Rd., Winston-Salem 

Isadore Meschan, M.D. (Radiology), Bowman 
Gray, Winston- Salem 

Chalmers R. Carr, M.D. (Ortho & Trauma- 
tology), 1822 Brunswick Avenue, Charlotte 

Mr. John Feagin (Student AMA), Duke Uni- 
versity School of Medicine, Durham 

Committee on Blue Shield (9) II-3 

Jacob H. Shuford, M.D., Chairman (1962), 

7 Main Avenue Place, S. W., Hickory 
W. Z. Bradford, M.D., (1961), 1509 Elizabeth 

Avenue, Charlotte 
Willard C. Goley, M.D. (1962), 214 N. Mar- 
ket Street, Graham 
William J. Cromartie, M.D. (1963), UNC 

School of Medicine, Chapel Hill 
John R. Hoskins, III, M.D. (1963), 203 Doc- 
tors Bldg., Asheville 
Julius A. Howell, M.D. (1961), Bowman Gray, 

Winston-Salem 
John W. Morris, M.D., (1962), 1707 Arendell 

Street, Morehead City 
E. Eugene Menefee, Jr., M.D. (1963), Duke 

Hospital, Durham 
Max P. Rogers, M.D. (1961), 624 Quaker 

Lane, High Point 
Committee Advisory to North Carolina State 
Board of Public Welfare (9) VI-2 
J. Street Brewer, M.D., Chairman, Box 98 

Roseboro 
Bruce B. Blackmon, M.D., Buies Creek 
Stephen R. Bartlett, Jr., M.D., 1001 E. 4th 

Street, Greenville 
Allyn B. Choate, M.D., 1012 Kings Drive, 

Charlotte 2 
Clyde R. Hedrick, M.D., 104 North Main 

Street, Lenoir 
J. Kempton Jones, M.D., 1001 S. Hamilton 

Road, Chapel Hill 
B. Bruce Langdon, M.D., 903 Hay Street, 

Fayetteville 
Wm. Raney Stanford, M.D., 111 Corcoran 

Street, Durham 
David G. Welton, M.D., 718 Professional 

Bldg., Charlotte 2 



296 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



10. Committee on Cancer (12) (Legal — 1 each 
Congressional District) VI-3 

James F. Marshall, M.D., Chairman. 310 W. 
4th Street, Winston-Salem 

Wm. H. Bell. Jr., M.D. (3rd), P. O. Box 1580, 
New Bern 

Joshua F. B. Camblos, M.D. (12th), 500 New 
Medical Bldg., Asheville 

Charles I. Hams, Jr., M.D. (1st), Martin 
General Hospital, Williamston 

Arthur B. Bradsher, M.D. (6th), 1200 Broad 
Street, Durham 

Harry V. Hendrick, M.D. (11th), Rutherford 
Hospital, Rutherfordton 

Harold A. Peck, M.D. (8th), Moore Mem- 
orial Hospital, Pinehurst 

Charles Glenn Mock, M.D. (10th), 200 Haw- 
thorne Lane, Charlotte 

David L. Pressly, M.D. (9th), 1025 Davie 
Street, Statesville 

Samuel L. Parker, Jr., M.D. (2nd), Kinston 
Clinic, Kinston 

Hubert McN. Poteat, Jr., M.D. (4th), 713 
Wilkins St., Smithfield 

D. Ernest Ward, Jr., M.D. (7th), 304 .Med- 
ical Arts Building, Lumberton 

11. Committee on Child Health (9) VI-4 
Angus M. McBryde, M.D., Chairman, 809 W. 

Chapel Hill Street, Durham 
P. J. McElrath, M.D., 500 St. Mary's Street, 

Raleigh 
Dan P. Boyette, Jr., M.D., 217 W. Main 

Street, Ahoskie 
Harrie R. Chamberlin, M.D., UNC School of 

Medicine, Chapel Hill 
Jean C. McAlister, M.D., 104 E. Northwood 

Street, Greensboro 
John W. Nance, M.D., 401 Cooper Drive, 

Clinton 
Wm. H. Patton, Jr., M.D., 305 College 

Street, Morganton 
Robert L. Vann, M.D., Bowman Gray, Win- 
ston-Salem 
Robert F. Poole, Jr., M.D., 817 Hillsboro 

Street, Raleigh 

12. Committee on Chronic Illness. Including 
Tuberculosis and Heart Disease (15) VI-5 
John R. Kernodle, M.D., Chairman, Kernodle 

Clinic, Burlington 

Stephen R. Bartlett, Jr., M.D., 1001 E. 4th 
Street, Greenville 

Robert H. Dovenmuehle, M.D., Duke Hospi- 
tal, Durham 

John D. Fitzgerald, M.D., 409 Roxboro Bldg., 
Roxboro 

Robert L. Garrard, M.D., 800 North Elm 
Street, Greensboro 

O. David Garvin, M.D., Health Department, 
Chapel Hill 

Robert A. Gregg, M.D., Central Convalescent 
Hospital, Greensboro 

Emery T. Kraycirik, M.D., Box 1153, Bur- 
lington 

Daniel A. McLaurin, M.D., 118 Main Street, 
Garner 

Thomas R. Nichols, M.D., 206 N. Sterling 
Morganton 

Elbert L. Persons, M.D., Duke Hospital, 
Durham 

John L. Shirey, M.D., 1 Battle Square, 
Asheville 

George L. Verdone, M.D., 1012 Kings Drive, 
Charlotte 

Donald D. Weir, M.D , N. C. Memorial Hos- 
pital, Chapel Hill 

Wm. H. Flythe, M.D., 624 Quaker Lane, 
High Point 



13. Committee on Constitution and By-Laws 
(5) II-4 

Roscoe D. McMillan, M.D., Chairman, Box 

232, Red Springs 
Millard D. Hill, M.D., 15 W. Hargett Street, 

Raleigh 
Edward W. Schoenheit, M.D., 46 Haywood 

Street, Asheville 
G. Westbrook Murphy, M.D., 103 Doctors 

Bldg., Asheville 
Louis deS. Shaffner, M.D., 300 S. Hawthorne 

Road, Winston-Salem 

1 I. Committee on Medical Credit Bureaus (7) 
II-5 

W. Howard Wilson, M.D., Chairman, 403 

Professional Bldg., Raleigh 
Fred K. Garvey, M.D., Bowman Gray, Win- 
ston-Salem 
John R. Hoskins, III, M.D, 203 Doctors 

Bldg., Asheville 
Bob Lewis Fields, M.D., Professional Bldg., 

Salisbury 
Lockert B. Mason, M.D., 1006 Murchison 

Bldg., Wilmington 
Ross S. McElwee, Jr., M.D., 1340 Romany 

Road, Charlotte 
Ralph J. Sykes, M.D., 205 Rawley Avenue, 

Mt. Airy 

15. Committee on Credentials of Delegates to 
House of Delegates (5) III-4 

T. Tilghman Herring, M.D., Chairman, Wil- 
son Clinic, Wilson 

Milton S. Clark, M.D., Wachovia Bank Bldg., 
Goldsboro 

James E. Hemphill, M.D., 1012 Kings Drive, 
Charlotte 

Robert M. Whitley, M.D., 144 Coast Line 
Street, Rocky Mount 

Charles B. Wilkerson, M.D., 100 S. Boylan 
Avenue, Raleigh 

16. Committee on Emergency Medical and 
Military Service (8) IV-1 

George W. Paschal, Jr., M.D., Chairman, 
1110 Wake Forest Road, Raleigh 

Chauncey L. Royster, M.D. Co-Chairman, 707 
W. Morgan Street, Raleigh 

Zackary F. Long, M.D., 304 E. Washington 
St., Rockingham 

Leslie M. Morris, M.D., Medical Building, 
Gastonia 

H. Mack Pickard, M.D., 7 N. 17th Street, 
Wilmington 

Daniel N. Stewart, Jr., M.D., 3 Third Ave- 
nue, N. W., Hickory 

Hugh F. McManus, Jr., M.D., 722 St. Mary's 
Street, Raleigh 

George A. Watson, M.D., 306 S. Gregson 
Street, Durham 

17. Committee on Scientific Exhibits (7) III-5 

Raphael W. Coonrad, M.D., Chairman, Broad 

& Englewood Sts., Durham 

Lenox D. Baker, M.D., Co-Chairman, Duke 

Hospital, Durham 
Wm. Henry Boyce, M.D., Bowman Gray, 

Winston-Salem 
Thomas B. Daniel, M.D., 700 W. Morgan 

Street, Raleigh 
Erie E. Peacock, Jr., M.D., N. C. Memorial 

Hospital, Chapel Hill 
O. Norris Smith, M.D., 1019 Professional 

Village, Greensboro 
Vernon H. Youngblood, M.D.. 609 Kannapo- 

lis Highway, Concord 






July, 1960 



SCHEDULE OF COMMITTEE APPOINTMENTS 



297 



18. Committee on Eve Care and Eye Bank (8) 
IV-2 

George T. Noel, M.D., Chairman, 211 

Raleigh Building, Kannapolis 
Win. Banks Anderson, M.D., Box 3802, Duke 

Hospital, Durham 
Horace M. Dalton, M.D., 400 Glenwood Ave- 
nue, Kinston 
Louten R. Hedgpeth, M.D., Medical Arts 

Building, Lumberton 
George Levi, M.D., 802 Glenwood Drive, 

Fayette ville 
Edward E. Moore, M.D., 706 Flatiron Bldg., 

Asheville 
J. David Stratton, M.D., 1012 Kings Drive, 

Charlotte 
George T. Thornhill, M.D., 720 W. Jones 

Street, Raleigh 

19. Committee on Finance (3) plus consultants 
1-1 

Wayne J. Benton, M.D., Chairman, 2320 
Battleground Road, Greensboro 

Lenox D. Baker, M.D., Duke Hospital, Dur- 
ham 

Arthur L. Daughtridge, M.D., Box 111, 
Rocky Mount 

Alexander Webb, Jr., M.D., Consultant, 231 
Bryan Bldg., Raleigh 

Graham B. Barefoot, M.D., Consultant. Box 
1198, Wilmington 

Newsom P. Battle, M.D., Consultant, 404 
Falls Road, Rocky Mount 

Isaac E. Harris, Jr., M.D., Consultant, 1200 
Broad Street, Durham 

Donald B. Koonce, M.D., Consultant, 408 N. 
11th Street, Wilmington 

Malory A. Pittman, M.D., Consultant, Wil- 
son Clinic, Wilson 

James P. Rousseau, M.D., Consultant, 1014 
West Fifth Street, Winston-Salem 

O. Norris Smith, M.D., Consultant, 1019 Pro- 
fessional Village, Greensboro 

Edward W. Schoenheit, M.D., Consultant. 46 
Haywood Street, Asheville 

John C. Reece, M.D., Consultant, Grace 
Hospital, Morganton 

A. Hewitt Rose, Jr., M.D., Consultant, 2009 
Clark Avenue, Raleigh 

20. Committee on Grievances (5) (1st Five Past 
Presidents) VIII-0 

James P. Rousseau, M.D., Chairman, 1014 
West Fifth Street, Winston-Salem 

John C. Reece, M.D., Secretary, Grace Hos- 
pital, Morganton 

Lenox D. Baker, M.D., Duke Hospital, Dur- 
ham 

Edward W. Schoenheit, M.D., 46 Haywood 
Street, Asheville 

Donald B. Koonce, M.D., 408 N. 11th Street, 
Wilmington 

21. Committee on Medical Golf Tournament 
(3) III-6 

Wm. A. Brewton, M.D., Chairman, 5 Lake 

Drive, Enka 
Ralph B. Garrison, M.D., 222 N. Main Street, 

Hamlet 
Charles W. Styron, M.D., 615 St. Mary's 

Street, Raleigh 

22. Committee on Hospital and Professional 
Relations and Liaison to North Carolina 
Hospital Association (10) V-l 

Theodore H. Mees, M.D., Chairman (5th), 
501 W. 27th Street, Lumberton 

Quinton E. Cooke, M.D., (1st), 209 E. Main 
Street, Murfreesboro 

Paul McNeely Deaton, M.D., (9th), 766 Hart- 
ness Road, Statesville 



John Tyler Dees, M.D., (3rd), Box 248, Bur- 

gaw 
Frederick C. Hubbard, M.D. (8th), Box 30, 

North Wilkesboro 
H. Lee Large, Jr., M.D. (7th), Presbyterian 

Hospital, Charlotte 
Arthur H. London, Jr., M.D. (6th), 306 S. 

Gregson Street, Durham 
Wm. A. Farmer, M.D. (2nd), 103 Davis 

Street, Fayetteville 
James S. Raper, M.D. (10th), Doctors Build- 
ing, Asheville 
Jack W. Wilkerson, M.D. (4th), Community 

Clinic, Stantonsburg 

23. Committee to Work with North Carolina 
Industrial Commission (6) II-6 

Thomas B. Dameron, Jr., M.D., Chairman, 
1313 Daniels Street, Raleigh 

Wm. F. Hollister, M.D., Moore County Hospi- 
tal, Pinehurst 

James S. Mitchener, Jr., M.D., Scotland 
County Memorial Hospital, Laurinburg 

Guv L. Odom, M.D., Duke Hospital, Durham 

Malory A. Pittman, M.D., Wilson Clinic 
Wilson 

Charles T. Wilkinson, M.D., 205 Waite Street, 
Wake Forest 

24. Committee on Insurances (7) IV-3 

Joseph W. Hooper, Jr., M.D., Chairman, 110 
N. 11th Street, Wilmington 

Robert H. Brashear, Jr., M.D., N. C. Mem- 
orial Hospital, Chapel Hill 

John C. Burwell, Jr., M.D., 1026 Professional 
Village, Greensboro 

Barry F. Hawkins, M.D., Ardsley Road, Con- 
cord 

Alban Papineau, M.D., Plymouth Clinic, Ply- 
mouth 

Henry B. Perry, Jr., M.D., 344 North Elm 
Street, Greensboro 

S. Glenn Wilson, M.D., Box 158, Angier 

25. Committee on Legislation (3 members plus 
President & Secretary) 10 Consultants) V-2 
Hubert McN. Poteat, Jr., M.D.. Chairman- 

(National), 713 Wilkins Street, Smithfield 
Lenox D. Baker, M.D., Duke Hospital, Durham 
Edgar T. Beddingfield, Jr., M.D., Co-Chair- 

man-( State), P. O. 137, Stantonsburg 
Amos N. Johnson, M.D., President (Ex Offi- 
cio), Garland 
John S. Rhodes, M.D., Secretary (Ex Officio), 

700 W. Morgan Street, Raleigh 
Daniel S. Currie, Jr., M.D. (Consultant), 111 

Bradford Avenue, Fayetteville 
Joseph S. Holbrook, M.D., (Consultant), 

Davis Hospital, Statesville 
Wm. E. Keiter, M.D. (Consultant) 400 Glen- 
wood Avenue, Kinston 
Donald B. Koonce, M.D. (Consultant), 408 N. 

11th Street, Wilmington 
Leslie M. Morris, M.D. (Consultant), Med- 

ica Building, Gastonia 
Zack D. Owens, M.D. (Consultant), Medical 

Building, Elizabeth City 
Robert Stuart Roberson, M.D. (Consultant), 

102 Brown Avenue, Hazelwood 
James P. Rousseau, M.D. (Consultant) 1014 

West Fifth Street, Winston-Salem 
Ben F. Royal, M.D. (Consultant), 907 Evans 

Street, Morehead City 
Thomas B. Dameron, Jr., M.D. (Consultant), 

1313 Daniels Street, Raleigh 
26. Committee on Maternal Health (14) VI-6 

James F Donnelly, M.D., Chairman (1966). 

State Board of* Health, Raleigh 
W. Joseph May, M.D., Secretary (8th), 121 

Professional Bldg., Winston-Salem 



298 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



Glenn E. Best, M.D., (3rd)-(1966), Main 

Street, Clinton 
Jesse Caldwell, Jr., M.D., (7th)-(1961), 114 

West Third Street, Gastonia 
P. J. McElrath, M.D. (6th)-(1961), 500 St. 

Mary's Street, Raleigh 
Milton' S. Clark, M.D. (4th)-(1961), Wacho- 
via Bank Bids'., Goldsboro 
W. Otis Duck, M.D. (10th)-(1963), Box 387, 

Mars Hill 
Wm. A. Hoggard, Jr., M.D. (lst)-(1965), 

1502 Carolina Avenue. Elizabeth City 
Wm. R. Wellborn, Jr., M.D. (9th)-(1964), 222 

W. Union Street, Morganton 
Frank R. Lock, M.D. (BG)-(1965), 300 S. 

Hawthorne Road, Winston-Salem 
Hugh A. McAllister, M.D. (5th)-(1965), 27th 

at Barker St., Lumberton 
Roy T. Parker, M.D. (Duke)-(1966), Box 

3517, Duke Hospital, Durham 
Robert A. Ross, M.D. (UNC)-(1963), N. C. 

Memorial Hospital, Chapel Hill 
H. Fleming Fuller, M.D. (2nd)-(1963), Kin- 

ston Clinic, Kinston 

27. Medical-Legal Committee (7) V-3 

Julius A. Howell, M.D., Chairman, Bowman 
Gray, Winston-Salem 

Theodore S. Raiford. M.D., 301 Doctors 
Bldg., Asheville 

David G. Weiton, M.D., 403 N. Tryon Street, 
Charlotte 

John W. Foster, M.D., Veterans Administra- 
tion, Winston-Salem 

Connell G. Garrenton, M.D.. Bethel Clinic, 
Bethel 

June U. Gunter, M.D., Watts Hospital, Dur- 
ham 

Bennette B. Pool, M.D., 414 Nissen Building, 
Winston-Salem 

2S Committee on Medical Care Armed Forces 
Dependents ("MEDICARE") (13) (plus 
Subcommittee Consultants — 19) II-7 

David M. Cogdell, M.D., Chairman. 911 Hay 

Street, Fayetteville 
George A. Watson, M.D., 306 S. Gregson 

Street, Durham 
Wm. H. Breeden, M.D., 1606 Morganton 

Road, Favetteville 
Everett I. Bugg, Jr., M.D., Broad and Engle- 

wojd Sts., Durham 
Jesse Caldwell, Jr., M.D.. 114 W. Third 

Street, Gastonia 
Daniel S. Currie, Jr., M.D., 111 Bradford 

Avenue, Favetteville 
Powell G. Fox, M.D., 1110 Wake Forest 
Road, Raleigh 

Wm. F. Hollister, M.D., Moore County Hos- 
pital, Pinehurst 
Donald B. Koonce, M.D., 408 N. 11th Street, 

Wilmington 
J. Douglas McRee, M.D., 2109 Clark Avenue, 

Raleigh 
Vernon L. Andrews, M.D., Box 407, Mt. Gilead 
A. Ledyard DeCamp, M.D., 1505 Elizabeth 

Avenue, Charlotte 
Donald H. Vollmer, M.D., 403 Doctors Bldg., 

Asheville 
A. — General Medicine 

John L. McCain, M.D., Chairman, Wilson 

Clinic, Wilson 
B. Joseph Christian, M.D., 948 Walker 

Avenue, Greensboro 
Leonard E. Fields, M.D., Box 788, Chapel 

Hill 
Joseph M. Hitch, M.D., 415 Professional 
Bldg., Raleigh 



B. — Radiology 

James E. Hemphill, M.D., Chairman, 
1012 Kings Drive, Charlotte 

Joe Lee Frank, Jr., M.D.. Roanoke- 
Chowan Hospital, Ahoskie 
C. — Surgery 

Wayne H. Stockdale, M.D., Chairman, 
703 North Street, Smithfield 

Howard M. Ausherman, M.D., 200 Haw- 
thorne Lane, Charlotte 

Fred K. Garvey, M.D., Bowman Gray, 
Winston-Salem 

George R. Miller, M.D., 412 Realty Bldg., 
Gastonia 

Guy L. Odom, M.D.. Duke Hospital, Dur- 
ham 

C. F. Siewers, M.D., 201 Churchill Drive, 
Favetteville 

Larry Turner, M.D., 1110 W. Main 
Street, Durham 
D. — Obstetrics & Gynecology 

John C. Burwell, Jr., M.D., Chairman, 
1026 Professional Village, Greensboro 

R. Vernon Jeter, M.D., Plymouth Clinic, 
Plymouth 

Trogler F. Adkins, M.D., 306 S. Gregson 
Street, Durham 
E. — Pediatrics 

Dan P. Boyette, Jr., M.D., Chairman, 217 
W. Main Street, Ahoskie 

Robert F. Poole, Jr., M.D., 817 Hillsboro 
Street, Raleigh 

George W. Kernodle. M.D., Medical Cen- 
ter Pharmacy Bldg., Burlington 

29. Committee on Menial Health (14) VI-7 
Allyn B. Choate, M.D., Chairman, 1012 Kings 

Drive, Charlotte 

Wilmer C. Betts, Jr., M.D., 2109 Clark Ave- 
nue, Raleigh 

E. W. Busse, M.D., Duke Hospital, Durham 

Milton S. Clark, M.D., Wachovia Bank Bldg., 
Goldsboro 

James F. Elliott, M.D., State Hospital, But- 
ner 

John W. Ervin, M.D., Box 132, State Hos- 
pital, Morganton 

John A. Fowler, M.D., 2212 Erwin Road, 
Durham 

Thomas T. Jones, M.D., 604 W. Chapel Hill 
Street, Durham 

Hans Lowenbach, M.D., Duke Hospital, Dur- 
ham 

Phillip G. Nelson, M.D., 1211 Rock Spring 
Road, Greenville 

James T. Proctor, M.D., 428 Ridgefield Road, 
Chapel Hill 

Walter A. Sikes, M.D., State Hospital, Ral- 
eigh 

Joseph B. Stevens, M.D., 1017 Professional 
Village, Greensboro 

David A. Young, M.D., 714 St. Mary's Street, 
Raleigh 

30. Committee on Necrology (3) IV-4 

Charles H. Pugh, M.D., Chairman, Box 527, 

Gastonia 
Charles T. Pace, M.D., Co-Chairman, 1802 

Independence, Greensboro 
Ben F. Royal, M.D., Box 628, Morehead City 

31. Committee on Negotiations (3) IX-0 

Wm. F. Hollister, M.D.. Chairman (term ex- 
pires 1961), Moore County Hospital, Pine- 
hurst 
Theodore S. Raiford, M.D. (term expires 

1963), 301 Doctors Bldg., Asheville 
Hubert McN. Poteat, Jr., M.D. (term ex- 
pires 1965), 713 Wilkins Street, Smith- 
field 



1960 



SCHEDULE OF COMMITTEE APPOINTMENTS 



299 



35. 



Chairman (9th) 7 
W., Hickory 
(7th), 114 W. Third 



913 Murchison 
Davis 



140 S. W. 

Bow- 

Build- 

Green- 

Wilson 

Doctors 



32. Nominating Committee 

Jacob H. Shuford, M.D., 
Main Avenue Place, S. 
Jesse Caldwell, Jr., M.D. 

Street, Gastonia 
Robert M. Fales, M.D. (3rd). 

Bldg., Wilmington 
Paul F. Maness, M.D. (6th), 328 W. 

Street, Burlington 
Robert M. McMillan, M.D. (5th), 

Broad Street, Southern Pines 
Charles M. Norfleet, Jr., M.D. (8th) 

man Gray, Winston-Salem 
Zack D. Owens, M.D. (1st), Medical 

ing, Elizabeth City 
Karl B. Pace, M.D. (2nd), Box 620, 

ville 
Malory A. Pittman, M.D. (4th), 

Clinic, Wilson 
James S. Raper, M.D. (10th), 103 
Bldg., Asheville 
33. Committee of Physicians on Nursing (8) IV-5 
Robert R. Cadmus, M.D., Chairman, N. C. 

Memorial Hospital, Chapel Hill 
Harry L. Brockmann, M.D., 624 Quaker 

Lane, High Point 
Badie T. Clark, M.D., Carolina General Hos- 
pital, Wilson 
James E. Davis, M.D., 1200 Broad Street, 

Durham 
Wm. D. James, Jr., M.D., Box 351, Hamlet 
David T. Smith, M.D., Duke Hospital, Durham 
Thomas J. Taylor, M.D.. 643 Roanoke Ave- 
nue, Roanoke Rapids 
Nursing and Nursing Education — Subcom- 
mittee 

Thomas J. Taylor, M.D., Chairman, 643 Ro- 
anoke Avenue, Roanoke Rapids 
Nursing Careers-Subcommittee 
Andrew J. Crutchfield, M.D., Chairman, 610 

W. Fifth Street, Winston-Salem 
Improvement of the Care of the Patient- 
Subcommittee 
Harry L. Brockmann, M.D., Chairman, 624 

Quaker Lane, High Point 
David T. Smith, M.D., Duke Hospital, Durham 

34. Committee on Occupational Health (9) VI-8 

Harry L. Johnson, M.D., Chairman, Box 



530, Elkin 
B. F. Cozart 

Reidsville 
B. Joseph Christian 

nue, Greensboro 
Mac Roy Gasque, M.D., Pisgah Forest 
W. B. Townsend, M.D., Box 420, Charlotte 
T. Beddingfield, Jr., M.D., 
Stantonsburg 



M.D., 1116 S. Main Street, 
M.D., 948 Walker Ave- 



P. O. Box 



M.D., 307 Woodburn 



M.D., N. C 
Chapel Hill 
M.D 



Memorial 



Edgar 

137, 
James Kent Rhodes, 

Rd., Raleigh 
Wm. P. Richardson, 

Hospital. Box 758, 
Logan T. Robertson, 

Street, Asheville 

Committee on Postgraduate 
(8) IV-6 

Samuel L. Parker, Jr., M.D... 

ston Clinic, Kinston 
Wayne J. Benton, M.D.. 2320 

Rd., Greensboro 
Richard C. Proctor, M.D., Bowman Gray, 

Winston-Salem 
W. Otis Duck, M.D., Box 387, Mars Hill 
Joseph A. Isenhower, M.D., 17 2nd Avenue, 

N. E., Hickory 
Wm. McN. Nicholson, M.D., Duke Hospital, 

Durham 



17 Charlotte 

Medical Study 

Chairman, Kin- 
Battleground 



36. 



37 



Frank R. Reynolds, M.D., 1613 Dock Street, 
Wilmington „ „ ,, . , 

Wm. P. Richardson, M.D., N. C. Memorial 
Hospital, Chapel Hill 

Committee on Poliomyelitis (14) VI-9 

Samuel F. Raveuel, M.D., Chairman, 104 t. 
Northwood Street, Greensboro 

Jay M. Arena, M.D., 1410 Duke University 
Road, Durham , _ .. ., 

Edward P. Benbow, Jr., M.D., 104 E. North- 
wood Street, Greensboro 

John W. Varner, M.D., Box 522, Lexington 
Charles R. Bugg, M.D., 627 W. Jones Street, 

Ralp^ B. Garrison, M.D., 222 N. Main Street, 

Hamlet . 

Wm. F. Harrell, Jr., M.D., Guaranty Bank 

Bldg., Elizabeth City 
Richard S. Kelly, M.D., 1606 Morganton 

Road, Fayetteville 
Donald B. Koonce, M.D., 408 N. 11th Street, 

Wilmington _ r „ 

Robert C. Pope, M.D., Wilson Clinic. Wilson 
Fiank H. Richardson, M.D., Children's Clinic, 

Black Mountain 

Box BB, Marshall 
M.D., 301 W. End Ave- 



38. 



M.D, Halifax County 
Halifax 
Relations (3) (7 Dis- 



M.D., Chairman, 
137, Stantonsburg 
(5th) (1961), 222 



Wm. A. Sams, M.D., 
Wm. G. Spencer. Jr., 

nue, Wilson 
Robert F. Young, 

Health Department, 

Committee on Public 
trict Consultants) V-4 

Edgar T. Beddingfield, Jr. 

(4th) (1962), P. O. Box 
Ralph B. Garrison, M.D. 

N. Main Street, Hamlet 
Courtney D. Egerton, M.D. (6th) (1963), 714 

St. Mary's Street, Raleigh 
Stephen R. Bartlett, Jr., M.D. (2nd) (consul- 
tant), 1001 E. 4th Street, Greenville 
Glenn E. Best, M.D., (3rd) (consultant), 

Main Street, Clinton 
Wm. H. Bureh, M.D., (10th) (consultant), 

Valley Clinic & Hospital, Bat Cave 
Joseph S. Holbrook, M.D., (9th) (consultant). 

Davis Hospital, Statesville 
Fred K. Garvey, M.D. (8th) (consultant), 

Bowman Grav, Winston-Salem 
Walter Spaeth, M.D. (1st) (consultant), 116 

South Road Street, Elizabeth City 
David G. Welton, M.D. (7th) (consultant), 

403 N. Tryon Street, Charlotte 
Committee on Physical Rehabilitation (8) 

George W. Holmes, M.D., Chairman, 2240 
Cloverdale Avenue, Winston-Salem 
Charles H. Ashford, M.D., 603 Pollock Street, 

New Bern 
F P. Dale, M.D., Kinston Clinic, Kinston 
J. Leonard Goldner, M.D., Duke Hospital, 



M.D- 



1313 Daniels 
N. 
M.D., 123 N. 
M.D., 405 



Center 
Second 
Colony 



39. 



Durham 
Walter S. Hunt, 

Street, Raleigh 
John Hays Rosser. M.D., 222 

Street, Statesville 
Marion B. Pate, Ji . 

Street, St. Pauls 
George H. Wadsworth, 

Avenue, Ahoskie 
Committee on Rural Health and General 
Practitioner Award (9) V-5 
R. Vernon Jeter, M.D., Chairman, Plymouth 

Clinic, Plymouth 
Philip E. Dewees, M.D., Box 217, Sylva 
Vernon W Taylor, Jr., M.D., 815 N. Bridge 

St., Elkin 



.••Slid 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



J. O. Williams. M.D., Cabarrus County Hos- 
pital, Concord 

George T. Wolff, M.D., 135 Bishop Street, 
Greensboro 

Charles T. Wilkinson. M.D., 209 Wilkinson 
Bldf?., Wake Forest 

Edward L. Bovette, M.D , Kenansville 

W. E. Swain, M.D., 201 E. 5th Street, Wash- 
ington 

John T. Dees, M.D., Box 248, Burgaw 

10. Committee on School Health and State 
Coordinating Service (9) VI-11 

Irma C. Henderson Smathers, M.D., Chair- 
man, 1295 Merrimon Avenue, AsheviUe 
Bruce B. Blackmon, M.D., Buies Creek 
Jean Davidson Craven, M.D., 19 W. 3rd Ave- 
nue, Lexington 
Charles H. Gay, M.D., 1012 Kings Drive, 

Charlotte 7 
Wm. C. Hunter, M.D., 103 Pine Street, Wil- 
son 
Floyd L. Knight. M.D , 103 Hillcrest Drive, 

Sanford 
Joseph S. Bower, M.D., Box 12, Pink Hill 
Robert C. Pope, M.D., Wilson Clinic, Wilson 
Wm. T. Rainey, Si\, M.D., Highsmith Hos- 
pital, Fayetteville 

11. Committee Advisory to Student A.M. A. 
Chapters in North Carolina (8) II-8 

John P. Davis, M.D., Chairman, 821 Nissen 

Bldg., Winston-Salem 
Edgar T. Beddingfield, Jr., M.D., P. O. Box 

137, Stantonsburg 
Charles G. Young, M.D., 135 Bishop Street, 

Greensboro 
Isaac E. Harris, Jr., M.D., 1200 Broad Street, 

Durham 
John W. Nance, M.D., Main Street, Clinton 
Robert A. Ross, M.D. (UNC Consultant), N. 

C. Memorial Hospital, Chapel Hill 
Wm. P. J. Peete, M.D. (Duke Consultant), 

Duke Hospital, Durham 
Robert L. McMillan, M.D. (BG Consultant), 

Bowman Gray, Winston-Salem 

42. Committee on Veterans Affairs (9) VI-12 
Samuel L. Elfmon, M.D., Chairman, 225 

Green Street, Fayetteville 
Vernon L. Andrews, M.D., Box 407 Mt. Gi- 

lead 
Wilmer C. Betts, M.D., 2109 Clark Avenue, 

Raleigh 
H. Francis Forsyth, M.D., Bowman Gray, 

Winston-Salem 
David L. Phillips, M.D., 110 Oak Avenue, 

Spruce Pine 
James D. Piver, M.D., 209 Bayshore Blvd., 

Jacksonville 
R. W. Postlethwait, M.D., VA Hospital, Dur- 
ham 
John T. Session^ Jr., M.D.. UNC Dapt. ot 

Medicine, Chapel Hill 
Charles R. Welfare, M.D., Professional 3idg., 

Winston-Salem 

43. Insurc-nce Industrv Liaison Committee 
(10) V-f 

Frank W. Jones, M.D., Chairman, Catawba 
Hospital, Newton 

Jack E. Mohr, M.D., Acting Chairman, Med- 
ical Arts Building, Lumberton 

Grover C. Bolin, Jr., M.D., Box 120, Smith- 
field 

Andrew J. Dickerson, M.D., 1600 N. Main 
Street, Waynesville 

Archie Y. Eagles, M.D., 407 Colony Avenue, 
Ahoskie 

Cleon W. Goodwin. M.D., Wilson Clinic, Wil- 
son 



Charles I. Harris, Jr., M.D., Martin General 
Hospital, Williamston 

Barry F. Hawkins, M.D., Ardsley Road, Con- 
cord 

James R. Wright, M.D., 604 Professional 
Bldg., Raleigh 

George T. Wolff, M.D., 135 Bishop Street, 
Greensboro 

II. Committee Liaison to Study Integration of 
Negro Physicians into Medici Society of 
State of North Carolina (7) 1-2 
J. Street Brewer, M.D., Chairman, P. O. Box 

98, Roseboro 
Paul F. Whitaker, M.D., 1205 N. Queen 

Street, Kinston 
Ben F. Royal, M.D., 900 Shepherd Street, 

Morehead City 
James P. Rousseau, M.D., 1014 West Fifth 

Street, Winston-Salem 
Joseph W. Hooper, Jr., M.D., 410 N. 11th 

Street, Wilmington 
James E. Hemphill, M.D., 1012 Kings Drive, 

Charlotte 7 
Henry B. Perry, Jr., M.D., 344 North Elm 

Street, Greensboro 



BULLETIN BOARD 



COMING MEETINGS 

North Carolina Urological Association, Annual 
Meeting — Greystone Inn, Roaring Gap, September 
25-26. 

North Carolina Fifth District Medical Society 
Meeting — Mid Pines Club, Pinehurst, October 5. 

Eleventh Annual Winston-Salem Heart Sympo- 
sium — Robert E. Lee Hotel, Winston-Salem, Octo- 
ber 7. 

Congress on Industrial Health — Hotel Charlotte, 
Charlotte, October 10-12. 

Duke University Medical Postgraduate Seminar 
Cruise to the West Indies — November 9-18. 

North Carolina Academy of General Practice, 
Annual Meeting — Carolina Hotel, Pinehurst, No- 
vember 27-30. 

Fifth International Congress on Nutrition — 
Sheraton Park and Shoreham Hotels, Washington, 
D.C., September 1-7. 

Southern Trudeau Society and Southern Tuber- 
culosis Society Meeting — Hotel Francis Marion, 
Charleston, South Carolina, Saptember 14-16. 

American Rhinologic Society, Sixth Annual Aleet- 

ing — Belmont Hotel, Chicago, October 8. 

American College of Surgeons, Forty-sixth An- 
nual Clinical Congress — San Francisco, October 
10-14. 

Inter-state Post-graduate Association, Forty- 
fifth Scientific Assembly — Pittsburgh, October 31- 
November 3. 



Julv, 1960 



BULLETIN BOARD 



301 



News Notes from the Duke University 
Medical Center 

A Duke University medical postgraduate sem- 
inar cruise to the Virgin Islands and Puerto Rico 
has been scheduled for next November. 

Plans for the cruise were announced by Dr. 
William M. Nicholson, assistant dean of the Duke 
Medical School in charge of postgraduate educa- 
tion. This cruise will replace one which has been 
scheduled for the Baltic area in June and which 
was cancelled, Dr. Nicholson said. 

Purpose of the medical cruises is to enable phy- 
sicians to combine postgraduate education with 
vacation travel. Lectures by Duke Medical Center 
faculty members are given aboard ship during 
the cruises. 

Physicians participating in the Virgin Islands 
cruise will sail from New York aboard the Swed- 
ish American Motorlines Kungsholm on November 
9. Stops will be made at St. John and St. Thomas 
in the Virgin Islands and at San Juan, Puerto 
Rico. The cruise will terminate at New York on 
November 18. 

Serving on the shipboard faculty will be Dr. 
Edwin P. Alyea, professor of urology; Dr. Nichol- 
son, professor of medicine; Dr. Elbert L. Persons, 
professor of medicine; Dr. William W. Shingleton, 
professor of surgery; and Dr. Doris A. Howell, 
associate professor of pediatrics. 

The lectures will deal with subjects that include 
thyroid abnormalities, chemical treatment of can- 
cer, arthritis, diabetes, and blood disease. The pro- 
gram will provide 30 hours of Category I, Post- 
graduate Education, required by the American 
Academy of General Practice. 

Information concerning the cruise may be ob- 
tained by writing to the Director of Postgraduate 
Education, Duke University Medical Center, Dur- 
ham, North Carolina. 

* * * 

A study aimed at the establishment of an In- 
stitute on Continued Patient Care has been 
launched at the Duke University Medical Center. 

Currently being evaluated by State public health 
officials, welfare leaders and others, the proposed 
institute would provide an educational program 
for workers in various health fields. Purpose of 
the program would be to mobilize and coordinate 
health services that are available to patients after 
their discharge from hospitals. 

David P. Henry, Duke Medical Center rehabili- 
tation coordinator who presided at a meeting held 
here to discuss the possibility of such a program, 
said that hospital patients are often unable to re- 
turn home when their condition permits discharge 
simply because no resources are readily available 
for the special home care that is required for 
them. 

In addition to local physicians, health personnel 
such as nurses, physical therapists, welfare workers 
and vocational rehabilitation counselors play im- 



portant roles in the home care of a patient after 
he leaves the hospital, Henry stated. Also, im- 
portant contributions in this area can be made by 
voluntary groups such as ministers civic clubs and 
women's clubs, he said. A coordinated follow-up 
program with clear-cut areas of responsibility 
would enable all these groups and persons to 
function effectively as a team. 

Among persons attending the Duke meeting, 
which was held to study the problem of follow- 
up care and to obtain all possible information for 
evaluation, were: Dr. Roy Norton, head of the 
N. C. Department of Public Health; Dr. Ellen 
Winston, head of the N. C. Department of Public 
Welfare; Dr. Amos Johnson of Garland, president 
of the N. C. Medical Society; William N. Ruffin of 
Durham, former president of the National Assn. 
of Manufacturers; Col. Charles Warren, director of 
the N. C. Office of Vocational Rehabilitation; Dean 
Edward McGavin of the University of North Car- 
olina School of Public Health; Dr. David Garvin 
of Chapel Hill, director of the Orange-Person- 
Chatham County Health District; Dr. James H. 
Semans, chairman of the Duke Medical Center's 
rehabilitation committee; F. Ross Porter, director 
of the Duke Medical Center Foundation; and Duke 
Hospital superintendent Charles H. Frenzel. 

Dean W. C. Davison of the Duke Medical School 
pointed out that in addition to lightening the cost 
of hospital care by permitting earlier discharges 
of many patients, this program could make possi- 
ble better care of the aged and chronically ill as 

well as the patient just home from the hospital. 
$ * $ 

The retiring dean of the Duke University School 
of Medicine, Dr. W. C. Davison, has been elected 
president of Alpha Omega Alpha, national Honor 
Medical Society. 

Dr. Davison, who retired as dean of the Duke 
Medical School on July 1, will retire from the fac- 
ulty in August, 1961. During his final year he 
will continue as James B. Duke Professor of Pedi- 
atrics. 

In electing Dr. Davison to head the national 
37,000-member body, the members of Alpha Omega 
Alpha placed the Duke dean among a select group 
of only five other persons who have been presi- 
dent of the society during its 58-year history. 

Dr. Davison, a member of the board of directors, 
succeeds Dr. Walter Lawrence Bierring of Des 
Moines, Iowa. 

Other Alpha Omega Alpha officers include 
Willard C. Rappleye of New York, vice-president; 
and Josiah J. Moore of Chicago, secretary- 
treasurer, both re-elected; and James A. Campbell, 
who was named secretary-treasurer-elect. 

How did the first man get to North America ? 

In an attempt to solve the ancient riddle, a Duke 
University research project has been launched 
under the direction of Dr. Daniel A. Livingstone 
of the Zoology Department faculty. A $25,600 



302 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



grant from the National Science Foundation will 
support the work over the next two years. 

Paul Colinvaux, Duke graduate student who is 
assisting Dr. Livingstone, has just arrived in Alas- 
ka. He will make care drillings to extract ma- 
terials from land under the lakes. 

After the materials are obtained, they will be 
brought to Duke where they will be examined for 
plant and animal microfossils, as well as for chem- 
ical indications of past environment. Radioisotopic 
techniques will be used. 

The Duke researchers hope to find out whether 
climatic conditions were the type which could have 
allowed man to cross to this continent. 



A new infant formula laboratory where some 
800 baby bottles are prepared each day under 
sterile conditions as exacting as those of an oper- 
ating room has been open opened at Duke Hospi- 
tal. The $45,000 facility replaces the previous 
formula laboratory and is four times as large. 

Mrs. A. H. Hampton, head nurse in the labora- 
tory, said that the unit provides formula for in- 
fants in the premature and newborn nurseries and 
for those on medical and surgical wards. As many 
as 25 different kinds and strengths of formula are 
made up daily according to doctors' specifications. 

Dr. Angus McBryde, professor of pediatrics, was 
instrumental in planning the laboratory, which is 
among the latest of a number of renovation pro- 
jects at the Duke Medical Center. 



News Notes from the University of 
North Carolina School of Medicine 

Awards and honors were announced by the Uni- 
versity of North Carolina School of Medicine at 
special exercises in honor of the 69 members of the 
graduating class. 

Dr. W. Reece Berryhill, dean of the school, pre- 
sided over the program and Dr. Nathan Womack, 
head of the Department of Surgery, was the prin- 
cipal speaker. A brief address also was given by 
James R. Harper of Chapel Hill, president of the 
graduating class. 

The American Medical Women's Association 
Scholastic Award went to Margaret B. Scales of 
Bay Shore, New York. 

Robert B. Payne of Gastonia received the Deb- 
orah C. Leary Memorial Award. 

The Isaac H. Manning Award was presented to 
Carwile LeRoy of Elizabeth City. 

The Mosby Book Awards were received by Ro- 
bert J. Cowan, Greensboro; Frederick D. Hamrick 
III, Rutherfordton; Zebulon Weaver, III, Asheville; 
Charles P. Eldridge, Jr., Raleigh and James R. 
Harper of Chapel Hill. 

The Roche Award went to William L. Black of 
Charlotte. 

Kenneth F. McCain of High Point and Carwile 
LeRoy of Elizabeth City were given the Sheard- 



Sanford Prizes of the American Society of Clin- 
ical Pathologists. 

The senior papers of 11 students were cited as 
excellent and have been bound and placed in the 
U.N.C. Division of Health Affairs Library. 

These papers were written by William L. Black, 
Charlotte; John R. Curtis, Bessemer City; Gerald 
W. Fernald, Wilson; Carwile LeRoy. Elizabeth 
City; Kenneth F. McCain, High Point; James M. 
Marlowe, Walstonburg; William N. Mical, Cincin- 
nati; Elwood E. Morgan, Burlington; Robert B. 
Payne, Gastonia; William S. Pearson, Statesville, 
and John C. Tayloe, Jr., of Washington. 

A total of 17 other senior papers were cited as 
being outstanding. 

* * * 

A number of faculty members of the University 
of North Carolina School of Medicine participated 
in the annual meeting of the American Medical 
Association in Miami in June. 

Drs. Richard L. Dobson and Donald C. Abelc of 
the Department of Medicine, and D. M. Hale, a 
research laboratory supervisor, presented a paper 
on "The Effect of High and Low Salt Intake and 
Repeated Episodes of Sweating on the Human 
Endocrine Sweat Gland." 

Dr. Charles H. Burnett, head of the Department 
of Medicine, serves on the executive committee of 
the Section of Experimental Medicine and Ther- 
apeutics. 

Drs. W. H. Akeson and D. S. Kellam prepared 
an exhibit entitled "Congenital Kyphosis: The 
Genesis of Microspondyly." Dr. Akeson is assistant 
professor of surgery and Dr. Kellam is a former 
resident in orthopedic surgery at N. C. Memorial 
Hospital and is now with the Charlotte Memorial 
Hospital. 

* * * 

The Home Savings and Loan Association of Dur- 
ham and Chapel Hill has established scholarships 
at the University of North Carolina School of 
Medicine which will amount to $1,000 annually by 
1963. 

The first scholarship, for $250, will be awarded 
to a first year medical student this fall and is re- 
newable for the entire four years of medical study. 
A similar award will be made each year to a stu- 
dent of the incoming- class of the School of Medi- 
cine. By 1963 four students will be receiving a 
total of $1,000 annually. 

The selection of the students for these scholar- 
ships and the conditions of satisfactory perform- 
ance necessary for annual renewal of them will be 
determinsd by the School of Medicine. 

In announcing the scholarship. Dr. William L. 
Fleming, assistant dean of the School of Medicine, 
explained that scholarships for medical schools 
were of particular importance at the present time, 
in view of the increasing need of physicians to 
keep pace with the population growth of the na- 
tion. 



July, 1960 



NORTH CAROLINA MEDICAL JOURNAL 



303 






Dr. Fleming said that the duration and cost of 
medical training was much higher than in other 
professional fields, making scholarships more 
needed. 

Dr. Colin G. Thomas, Jr., of the Department of 
Surgery and Dr. John T. Sessions of the Depart- 
ment of Medicine spoke before the annual meeting 
of the Seaboard Medical Association at Nags Head 
recently. Dr. Thomas talked on "The Timing and 
Selection of Surgical Procedures in the Manage- 
ment of Pancreatitis," and Dr. Sessions discussed 
the topic, "Does Alcohol Damage the Liver When 
Taken Before, After or Instead of Meals." 

Dr. Ernest H. Wood, professor of radiology, 
was elected vice president of the American Board 
of Radiology at its annual trustee meeting in Cin- 
cinnati. He has been a trustee of the board for 
several years. 

$ * * 

A student of the University of North Carolina 
School of Medicine will spend this summer work- 
ing in a small, remote hospital in the Philippine 
Islands. 

Colonel D. Bessinger, Jr., of Asheville, who will 
graduate from the U.N.C. School of Medicine next 
June will spend the summer working in a small 
remote hospital in the Philippines. His work will 
be under the sponsorship of the Foreign Mission 
Board of the Southern Baptist Convention. This 
project is made possible by a grant of $1,985 from 
the Smith, Kline and French Foreign Fellowship, 
which is administered by the American Associa- 
tion of Medical Colleges. 

Working with physicians already practicing at 
Mati, Bessinger will help with the public health 
program and at the same time gain valuable clin- 
ical experience. In addition, he will serve as a 
"goodwill ambassador" representing American 
medical schools in bringing the latest medical tech- 
niques and procedures to remote hospitals and 
clinics. 

* * * 

Dr. Judson J. Van Wyk, associate professor of 
pediatrics will present three lectures in Europe 
during June and July. 

He will speak in Switzerland, England and Den- 
mark and will also visit various endocrine clinics 
in France, Germany and Holland. 

Dr. Van Wyk will address the Zurich Kinder 
Klinik in Zurich, Switzerland, on "Genetic Factors 
in Staple Goiter." 

He will speak before the Fourth International 
Goiter Congress, which meets in London July 5-8. 
This lecture also will deal with the inherited as- 
pects of goiter. 

Dr. Van Wyk will attend the First International 
Endocrine Congress in Copenhagen, Denmark 
July 18-23. Here he will lecture on "Syndrome of 



Precocious Menstruation and Galactorrhea in Ju- 
venile Hypothyroidism: An Example of Hormonal 
Overlap in Pituitary Feedback." 



Four psychiatrists of the staff of N. C. Mem- 
orial Hospital of the University of North Carolina 
have been cited for outstanding theses submitted 
in connection with their three-year residency 
training here. 

They are Dr. J. Iverson Riddle, Morganton; Dr. 
Rex Speers, Claremont; Dr. George Thrasher. Ro- 
anoke, Virginia, and Dr. Andrew Briggs of Rich- 
mond. 

Dr. Riddle took first place and Dr. Speers was 
awarded second place for the Anclote Manor Hos- 
pital Prize. These awards were $150 and $50. 

The title of Dr. Riddle's thesis was "Mental Sub- 
normality: Its Place in Psychiatric Residency 
Training Program." Dr. Speers' thesis was "Brief 
Psychotherapy with College Women — Technique 
and Criteria for Selection." 

Dr. Thrasher and Dr. Briggs received honorable 
mention for their theses. 

The medical director of Anclote Manor Hospital 
at Tarpon Springs, Florida, is Dr. Lorant Forizs, 
former faculty member of the Department of Psy- 
chiatry of the U.N.C. School of Medicine. The 
awards were made here and Dr. Forizs was on 
hand for the presentations. 

The theses submitted by the four physicians 
were required as a part of their specialized train- 
ing in psychiatry. All four men completed their 
training in June. 



News Notes from the 
Bowman Gray School of Medicine 

Dr. C. C. Carpenter, dean of the Bowman Gray 
School of Medicine, has announced that on July 1 
Dr. William H. Boyce will assume his new duties 
as director of the Section on Urology, Department 
of Surgery. He will replace Dr. Fred K. Garvey. 

Dr. Garvey, head of the section since 1941, will 
continue as professor of urology on the full-time 
faculty of the medical school and on the staff of 
the urologic service of the North Carolina Baptist 
Hospital. 

Dr. Boyce, a graduate of Vanderbilt University 
School of Medicine, completed his residency train- 
ing in urology at the Cornell University Medical 
Center and the University of Virginia Hospital be- 
fore joining the faculty of the Bowman Gray 
School of Medicine in 1952. He has made outstand- 
ing- contributions in the field of research and has 
contributed widely to the medical literature. He is 
a member of the American Association of Genito- 
urinary Surgeons, the American Board of Urology, 
the Clinical Society of Genito-Urinary Surgeons 
and the Society of University Surgeons. 



304 



NORTH CAROLINA MEDICAL JOURNAL 



July, 19(50 



Three new faculty appointments have been an- 
nounced by the dean of the Bowman Gray School 
of Medicine. 

The appointments, effective July 1, are: Dr. 
Henry S. Miller, instructor in internal medicine; 
Dr. Herman E. Schmid, Jr., instructor in physiol- 
ogy and pharmacology; and Dr. Robert P. Thomas, 
instructor in ophthalmology. 

Dr. Miller is a graduate of Bowman Gray 
School of Medicine and has just finished his resi- 
dency training in medicine here. 

Dr. Schmid, a graduate of the University of 
Chicago College of Medicine, interned at the Mil- 
waukee County Hospital, Milwaukee, Wisconsin, 
and served as a house physician at the Santa Cruz 
County Hospital, Santa Cruz, California. He has 
also served one year as administrator of the 
Grants and Training Branch, National Heart In- 
stitute, National Institutes of Health, Bethesda, 
Maryland. 

Dr. Thomas is a graduate of the University of 
North Carolina School of Medicine and was en- 
gaged in general practice for two years before 
joining the house staff of the North Carolina Bap- 
tist Hospital in 1957 as an assistant resident in 
ophthalmology. 



* * * 



Dr. C. Hampton Mauzy, professor of obstetrics 
and gynecology, has assumed supervision of ob- 
stetrics at the medical school and the N. C. Bap- 
tist Hospital under the chairmanship of Dr. Frank 
R. Lock. This will enable Dr. Lock to devote more 
of his time to the direct supervision of gynecologic 
work. Dr. Mauzy joined the faculty of the medical 
school in 1941. 



Dr. Frank H. Hulcher, instructor in biochemis- 
try, is engaged in work as i-esearch collaborator at 
the Brookhaven National Laboratories, Upton. 
Long Island, New York, for the months of June, 
July and August. 



Dr. Wingate M. Johnson, professor emeritus of 
clinical internal medicine, presented a paper en- 
titled, "Medical Care of Older Patients," at the 
June meeting of the American Medical Associa- 
tion at Miami Beach, Florida. Dr. Johnson is a 
former trustee of the A.M. A. and an ex-officio 
member of the House of Delegates. He is also on 
the national and state committees for care of the 
aged. 

* * * 
Dr. Howard H. Bradshaw, chairman of the De- 
partment of Surgery, delivered the first Julian A. 
Moore Memorial Lecture at the June meeting of 
the Buncombe County Medical Society in Asheville. 
The title of Dr. Bradshaw's talk was, "Advances 
Made in Surgical Treatment of Pulmonary Tuber- 
culosis." 



On July 1, 101 doctors will begin house staff ap- 
pointments at the North Carolina Baptist Hospital 
and the Bowman Gray School of Medicine. Of the 
total number, 68 doctors have served previous 
residencies and internships here, and 33 are be- 
ginning training here for the first time. 

The new appointments are: 

Anesthesiology: assistant resident — Dr. J. Rich- 
ard R. Bobb. 

Medicine: resident — Dr. Thomas N. Massey, Jr.; 
assistant residents — Drs. Dean F. Gray, John D. 
Hines, Phillip A. Sellers; interns — Drs. John D. 
Bradley, Jr., Paul R. Brown, Milton S. Goldman, 
James N. Hinson, George William Joyce, John 
Scott Miller, Jr., Bernard S. Morse, and Isaiah J. 
Seligman. 

Neurosurgery: assistant resident — Dr. Trave L. 
Brown, Jr. 

Obstetrics and Gynecology: assistant residents 
— Drs. Sam Jones Crawley, Jr. and Edward C. 
Sutton. 

Ophthalmology: assistant resident — Dr. Withrow 
R. Legge, Jr. 

Orthopaedics: assistant residents — Drs. Louis B. 
Daniel, Jr. and Frank Sellers. 

Otolaryngology: assistant resident — Dr. Robert 
F. Thompson. 

Pathology: assistant residents — Drs. William R. 
Beach, III, Stephen Mamick, Modesto Scharyj, 
and Franklin Bailey Wilkins; intern — Dr. Robert 
E. Jones, Jr. 

Pediatrics: assistant resident — Dr. Max Lassiter. 

Radiology: assistant residents — Drs. James V. 
Blazek, Ronald L. Kelly, Jr., and James L. Quinn, 
III. 

Surgery: assistant residents — Drs. W. Claude 
Hollingsworth, William G. Montgomery, and Earl 
P. Welch; intern — Dr. Tim Pennell. 

Four new physicians have been appointed for 
postdoctoral training as fellows. They are: Drs. 
William B. Courtney, Fritz R. Dixon, and Sidney 
Girsch, pathology; and Richard B. Patterson, 
pediatric-hematology. 



News Notes 

Dr. C. A. Kimel has announced the opening of 
his office for general practice at Ebert Street Ex- 
tension and West Clemmonsville Road, Winston- 
Salem. 



EDGECOMBE-NASH MEDICAL SOCIETY 

The monthly meeting of the Edgecombe-Nash 
Medical Society was held in Rocky Mount on 
June 8. 

Dr. A. W. Hedgepeth, program chairman for 
June, introduced the speaker, Dr. Paul Bunch, who 
discussed pediatric surgery from a urologic stand- 
point. 



July, 1960 



BULLETIN BOARD 



305 



Inter-State Post-Graduate Association 

The Inter-State Post-Graduate Association will 
hold its forty-fifth Scientific Assembly at the 
Pittsburgh Hilton Hotel on October 31 to Novem- 
ber 3. Pre-registration, accommodations, informa- 
tion, and other communications may be addressed 
to Mr. Roy T. Ragatz, Executive Director, at Box 
1109, Madison 1, Wisconsin. 

Twenty-one of the subjects are to be devoted to 
subject of medicine, nine to surgery, one to radiol- 
ogy, one to otolaryngology, and one to social ec- 
onomics. 

The program is approved for postgraduate edu- 
cation, Category I, by the American Academy of 
General Practice. 



having programs in Chile. These included Catholic 
Relief Service, Church World Service, CARE, 
Seventh Day Adventists Welfare Service, and the 
Church of Jesus Christ of Latter Day Saints. 

As General Gruenther explained, "The impact of 
voluntary contributions by individuals on the suf- 
fering people of Chile will be tremendous." 

In addition to the contributions of individuals, 
tons of food, medical supplies, tents and other aid 
were immediately airlifted to help the homeless 
and the helpless. The American Red Cross and 
numerous other organizations made emergency 
allocations from their own funds and began to 
campaign for funds and relief supplies for a long- 
range program to help the people of Chile. 



American Board of 
Obstetrics and Gynecology 

The next scheduled examination, (Part I), writ- 
ten, will be held in various cities of the United 
States, Canada, and military centers outside the 
Continental United States, on Friday, January 13, 
1961. 

Candidates submitting applications in 1960 for 
the 1961 examinations are not required to submit 
case reports as previously required to complete 
the Part I examinations of this Board. In lieu of 
this requirement, new candidates are required to 
keep in their files a duplicate list of hospital ad- 
missions as submitted with their application, for 
submittal at the annual meeting in Chicago should 
they become eligible to take the Part II (oral) ex- 
aminations. 

Reopened candidates will be required to submit 
case reports for review thirty days after notifica- 
tion of eligibility. Scheduled Part I and candidates 
resubmitting case reports are required to submit 
Case Reports prior to August 1 each year. 

Current bulletins may be obtained by writing to: 
Robert L. Faulkner, M.D. 
Executive Secretary and Treasurer 
2105 Adelbert Road 
Cleveland 6, Ohio 






AMERICAN NATIONAL RED CROSS 
The Chilean earthquake disaster, one of the 
worst in modern times, has demonstrated again 
the characteristic generosity of Americans toward 
people in trouble. 

Chile suffered this disaster during May, leaving 
hundreds of thousands of Chileans cold, sick, in- 
jured and homeless. Not only was emergency re- 
lief needed but a long-range recovery program of 
gigantic pi-oportions was necessary. 

At President Eisenhower's request, General Al- 
fred M. Gruenther, president of the American Red 
Cross, became coordinator for voluntary Chilean re- 
lief. Citizens were urged to make their contribu- 
tions to the American Red Cross or other agencies 



AMERICAN COLLEGE OF SURGEONS 
Improvement in the total care of surgical pa- 
tients will be the goal of 10,000 doctors expected 
to attend the forty-sixth annual Clinical Congress 
of the American College of Surgeons in San Fran- 
cisco, California, October 10 through 14. 

More than 1,000 participants will take part in 
the various programs as authors of research re- 
ports, teachers of postgraduate courses, partici- 
pants in panel discussions, lecturers, and operating 
surgeons in motion pictures and closed-circuit tele- 
casts. 

On the final evening, October 14, initiates will be 
presented for fellowship, honorary fellowships con- 
ferred, and officers inaugurated. 



NATIONAL LEAGUE FOR NURSING INC. 

Admissions to schools of professional and prac- 
tical nursing reached an estimated 71,297 new 
students in 1959, compared with 68,851 in 1958, 
according to an announcement by Fred C. Foy, 
chairman, Committee on Careers, National League 
for Nursing, New York. 

Professional nursing programs admitted 47,797 
new students, a slight increase over the 47,351 ad- 
missions of the preceding year. Practical nursing 
schools enrolled an estimated 23,500 students in 
1959, compared with 21,500 in 1958. 



CATHOLIC HOSPITAL ASSOCIATION 
Officers elected at the forty-fifth annual con- 
vention of the Catholic Hospital Association of the 
United States and Canada in Milwaukee, Wiscon- 
sin, recently included The Rt. Rev. Msgr. A. W. 
Jess, Camden, New Jersey, who took over the du- 
ties of president from Father John J. Humensky, 
Cleveland, Ohio. Sister M. Christine, C. C. V. I., 
of St. Joseph's Hospital, Houston, Texas, was 
elected to represent the Southern section of the 
United States, and Sister John Joseph, C.S.J., of 
Santa Rosa Hospital, Santa Rosa, California, to 
represent the Western section. 



nut; 



NORTH CAROLINA MEDICAL JOURNAL 



July. 19G0 






AMERICAN HEARING SOCIETY 
Philip M. Morgan, industrialist, civic leader, and 
philanthropist of Worcester, Massachusetts, was 
re-elected president of the American Hearing So- 
ciety at its forty-first annual conference in Detroit 
(May 24-27), attended by professional workers in 
the field of hearing and representatives of the 
agency's lay membership from all pails of the 
country. Program for the four-day meeting cen- 
tered on the theme "Communication: Key to Liv- 
ing." 

Re-elected as officers of the society were: first 
vice president — Miss Mary E. Switzer, director, 
Office of Vocational Rehabilitation, Department of 
Health, Education, and Welfare; second vice pres- 
ident — James McKnight Timmons, M.D.; of Co- 
lumbia, South Carolina, and treasurer — E. B. 
Whitten, executive director of the National Re- 
habilitation Association. 



Biological Photographic Association Inc. 

Photographers and scientists interested in the ap- 
plication of new photographic techniques and 
equipment in the field of biology will convene in 
Salt Lake City, Utah, this summer for the 
thirtieth annual meeting of Biological Photographic 
Association. The meeting will be held August 23 
through 26, with headquarters at the Hotel Utah 
Motor Lodge. 



AMERICAN GERIATRICS SOCIETY 
The Willard 0. Thompson Memorial Award "for 
distinguished contributions to geriatric medicine" 
was presented to Dr. William B. Kountz of St. 
Louis, Missouri, at the annual dinner of the Amer- 
ican Geriatrics Society held recently at Miami 
Beach. 

Presentation of the award was made by Dr. Ed- 
ward Henderson, chairman of the Society's Award 
Committee and editor of the Journal of the Amer- 
ican Geriatrics Society, on the occasion of the so- 
ciety's seventeenth annual meeting. A professional 
organization with a membership of more than 
7,000 physicians, the society has as its purpose 
encouraging and promoting the study of geriatrics. 
The Willard O. Thompson Memorial Award, which 
includes an honorarium and a medal, is given an- 
nually to an outstanding specialist in geriatric 
medicine. 



BLUE SHIELD MEDICAL CARE PLANS 
Chairman of the Board of the National Asso- 
ciation of Blue Shield Plans, was named one of 
three national civic leaders to receive the I960 
"Health-USA" award sponsored jointly by the 
Metropolitan Washington (D.C.) Board of Trade 
and the Medical Society of the District of Colum- 
bia. Dr. Stubbs, who has held important posts in 
Blue Shield both at the local and national levels 



adult 

stable 
diabetics 

and a 

significant 

number of 

sulfonylurea 

failures 
respond to 




trademark, 
brand of Phenformin HCI 



adult stable diabetes 

"In our experience the action of DBI on the adult stable 
type of diabetes is impressive . . . 88% were well controlled 
by DBI."i 

"Most mild diabetic patients were well controlled on a 
biguanide compound [DBI], and such control was occa- 
sionally superior to that of insulin. This was true regardless 
of age, duration of diabetes, or response to tolbutamide." 2 

"DBI has been able to replace insulin or other hypogly- 
cemic agents with desirable regulation of the diabetes when 
it is used in conjunction with diet in the management of 
adult and otherwise stable diabetes." 3 



sulfonylurea failures 

Among those diabetics who responded to tolbutamide ini- 
tially and became secondary failures DBI "gave a satis- 
factory response in 55%. " 4 

"DBI is capable of restoring control in a considerable por- 
tion of patients in whom sulfonylurea compounds have 
failed, either primarily or secondarily." 5 

"All twelve secondary tolbutamide failures have done well 
on DBI." 6 

"34 out of 59 sulfonylurea primary failures were success- 
fully treated with DBI." 7 






July, 1960 



BULLETIN BOARD 



307 



during the past decade, was selected for ". . . . his 
distinguished contributions to the health of the 
American people." Dr. Stubbs received the "Health- 
USA" award at a testimonial luncheon held in 
Washington, D. C. on June 1. Present at the award 
luncheon were Secretary Flemming, members of 
Congress and medical leaders. 

The two other recipients of the "Health-USA" 
awards, which are given annually to recognize 
"Statesmanship in Health," are Major General 
Howard McC. Snyder, physician to the President of 
the United States, and Elmer H. Bobst, Chairman 
of the Board of Warner-Lambert Pharmaceutical 
Company. 



U. S. Department of 
Health, Education, and Welfare 

Douglas H. K. Lee, M.D., has been appointed 
chief of the research headquarters of the Occu- 
pational Health Program, Public Health Service, 
U. S. Department of Health, Education, and Wel- 
fare, at Cincinnati, Ohio. In his new position, Dr. 
Lee will be responsible for directing technical re- 
search and field studies of occupational health 
problems and professional and technical consulta- 
tion services to state agencies, labor, and industry. 



Statement by Surgeon General Leroy E. Burney 

Public Health Service scientists have been at- 
tending the Second International Conference on 
Poliomyelitis which has been meeting in Washing- 
ton this week under the auspices of the World 
Health Organization. During the past year our 
staff have been following very closely the live 
virus trials in various parts of the world. This 
week, as a matter of fact, Dr. David E. Price, who 
served as my personal representative at a series 
of polio meetings in Moscow in mid-May, has 
made public a report on the use of live virus in 
the USSR during the past year. 

I want to emphasize very strongly that the Pub- 
lic Health Service and I, as Surgeon General, have 
the responsibility for making sure that biological 
products are safe and effective. We take that re- 
sponsibility very seriously. When the technical ex- 
perts of the National Institutes of Health and 
their highly competent advisers are satisfied on 
these two points, it will be possible to license a 
live polio vaccine but not before. How soon that 
will be, I do not know. 

I should point out that, so far, only one manu- 
facturer has applied for a license. This request 
was returned for additional information; and no 
applications are now pending. 

In the meantime we have in the Salk vaccine a 
proved and highly effective means for fighting 





lowers 
blood sugar 

in mild, 

moderate 

and severe 

diabetes, 

in 

children 



not a sulfonylurea... DBI 

(N 1 -(3-phenethylbiguanide) is 
available as white, scored tablets of 
25 mg. each, bottles of 100. 

Send for brochure with complete dosage 
instructions for each class of diabetes, 
and other pertinent information. 



1. Walker, R. S.: Brit. M. J. 2:405. 1959. 

2. Odell, W. D., et al.: A.M. A. Arch. Int. Med. 
102:520, 1958. 

3. Pearlman, W.: Phenformin Symposium. 
Houston, Feb. 1959. 

4. DeLawter, D. E., et al.: J.A.M.A. 171:1786 
(Nov. 28) 1959. 

5. McKendry, J. B., et al.: Canad. M. A. J. 
80:773, 1959. 

6. Miller, E. C: Phenformin Symposium, 
Houston, Feb. 1959. 

7. Krall, L. P.: Applied Therapeutics 2:137, 1960. 

an original development from the research 
laboratories- of 

u. s. vitamin & pharmaceutical corp. 

Arlington-Funk Laboratories, division 
250 East 43rd Street, New York 17, N. Y. 



308 



NORTH CAROLINA MEDICAL JOURNAL 



July, 19K0 



polio. It has been administered to about 80 million 
Americans during the past five years, and, despite 
a high polio incidence in the summer of 1950, it 
has proved over 90 percent effective when the re- 
commended course of injections is followed. 

Unquestionably, a vaccine which can be admin- 
istered orally and is less expensive to produce 
would represent another major advance in the 
fight against polio throughout the world. 

We want to be very sure that it is entirely safe 
and fully effective. When these two principles are 
fully established by a qualified manufacturer, we 
will be happy to grant licenses for its production. 



United States Civil Service Commission 

The Civil Service Commission has announced 
the appointment of a five-man committee, repre- 
senting the health insurance industry, to advise it 
in connection with the government-wide indemnity 
benefit plan, one of four types of health benefit 
plans to be offered federal employees under the 
new Federal Employees Health Benefits program. 

Classified Advertisements 

X-RAY Equipment for sale or exchange. 100 K.V. 
100 M.A. Picker Radiographic unit with manual 
operated tilt table combined with Fluoroscope 
unit beneath the table. Provides instant change 
over from Fluoroscopy to Radiography with spot 
film device. Has had some use but is in excellent 
working order also dark room equipment, mag- 
netic type plate changer. Stereoscopic view boxes, 
etc., will consider late model Ultra-violet lamp, 
surgical endotherm in exchange. Write Box 790. 
Raleigh, North Carolina. 

AVAILABLE Desirable twelve hundred and fifty 
square feet space suitable for doctors or dentist, 
(iround floor Cameron Court apartments, corner 
Snow and Morgan Streets, Raleigh. Air con- 
ditioned, also heat, lights, water and parking. 
On long lease will improve to suit tenant. Apply 
A. W. Criddle, Manager, Temple 2-5395. 

OPENINGS for psychiatrists, pediatricians and 
general physicians for varied assignments with 
North Carolina state hospitals and institutions 
for retarded children. Several locations available. 
Opportunity for all types of therapy, collabora- 
tion or individual research in service training. 
Medical school affiliations offers opportunity for 
university appointment. Entire program operates 
in close association with university program. Re- 
tirement, Social Security, and other attractive 
benefits including recent substantial increase in 
salaries for psychiatrists, pediatricians and gen- 
eral physicians. For particulars write Eugene 
A. Hargrove, M.D., Commissioner of Mental 
Health, P.O. Box 70, Raleigh, North Carolina. 

DESIRABLE LOCATION for a physician. Contact 
Godley Realty Company, Mt. Holly Road, Char- 
lotte, North Carolina. 



The Month in Washington 

An omnibus bill approved by the House 
Ways and Means Committee contains two 
provisions of major importance to physi- 
cians — Social Security coverage for doctors 
and a federal-state program to provide 
health care for older persons with low in- 
comes. 

About 150,000 self-employed physicians 
would be covered by Social Security on the 
same basis as lawyers, dentists and other 
self-employed professional people now are 
covered. Becoming effective for taxable 
years ending on December 31, I960, or 
June 30, 1961, self-employed physicians 
would be required to pay a Social Security 
tax of 4'o per cent of the first $4,800 of 
income. Physicians also would be subject 
to the automatic increases in the Social Se- 
curity tax in future years. 

Medical and dental interns would be 
covered for the first time also. 

Representative Wilbur Mills (D., Ark.), 
Chairman of the Ways and Means Commit- 
tee, was the main architect of the health 
program for "medically indigent" aged. It 
was designed to provide a broad range of 
hospital, medical and nursing services for 
persons 65 years of age and older who are I 
able financially to take care of their ordin- 
ary needs but not large medical expenses. I 

It would be up to each state to decide 
whether it participates in the program. The 
extent of participation — the number of 
benefits offered to older persons — also 
would be at the option of individual states. 

The states would determine the eligibility 
of older persons to receive benefits under 
the program. However, the legislation laid 
down a general framework for eligibility; 
persons 65 years and older, whose income 
and resources — taking into account their 
other living requirements — are insufficient 
to meet the cost of their medical care. 

The program couldn't become effective : 
until July 1, 1961. Before putting such a 
program into effect, a state would have ta 
submit to the federal government a plan 
meeting the general requirements outlined 
in the legislation. 

The program would be financed jointly 
by the federal and state governments. Fed- 
eral grants would have to be matched by 
participating states on the same basis as 



From W r ashingrton Office. American Medical Association 
1523 L Street. N.W. 



July, 1960 



THE MONTH IN WASHINGTON 



309 



under the present-old age assistance formu- 
la. 

States could elect to provide, with federal 
financial aid, any or all of the following 
benefits: (1) Inpatient hospital services up 
to 120 days per year; (2) skilled nursing- 
home services; (3) physicians' services; 
(4) outpatient hospital services; (5) or- 
ganized home care services; (6) private 
duty nursing services; (7) therapeutic 
services; (8) major dental treatment; (9) 
laboratory and x-ray services up to $200 
per year, and (10) prescribed drugs up to 
$200 per year. 

The committee put a $325 million price 
tag on the program for the first full year 
of operation — $185 million federal and 
$140 million state. This estimate, however, 
could hardly be more than an educated 
guess of sorts. The actual cost would de- 
pend upon unpredictable factors — how 
many states would participate, how many 
benefits they would offer, and how many 
older persons would qualify and what serv- 
ices they would require. 

The committee estimate was based on 
between 500,000 and 1 million older per- 
sons a year receiving health services under 
the program. If all states participated 
fully, the committee said, potential protec- 
tion would be provided as many as 10 mil- 
lion aged whose financial resources are so 
limited that they would qualify in case of 
serious or extensive illness. 

Payments under the program would go 
directly to physicians and other providers 
of medical, hospital and nursing services. 

In addition to the federal grants for the 
"medically indigent," about $10 million 
more in federal funds would be authorized 
for payment to states for raising the stan- 
dards of medical care benefits under pre- 
sent public assistance programs for older 
persons. 

The approach of the Mills program was 
similar to that of Point 2 of the American 
Medical Association's 8-point program for 
health care of the aged. Point 2 stated that 
the A.M. A. supports federal grants-in-aid 
to states "for the liberalization of existing 
old-age assistance programs so that the 
near-needy could be given health care with- 
out having to meet the present rigid re- 
quirements for indigency." Such a liberal- 
ized definition of eligibility should be de- 
termined locally, the A.M. A. said. 



Approval of the Mills plan by the com- 
mittee marked a sharp setback for organ- 
ized labor leaders. But they continued their 
all-out pressure campaign in an effort to 
get Congressional approval of Forand-type 
legislation that would use the Social Secur- 
ity system to provide hospitalization and 
medical care for the aged. After being de- 
feated in the Ways and Means Committee, 
labor union leaders and other supporters of 
Forand-type legislation directed their ma- 
jor efforts to trying to get the Senate to 
substitute the Social Security approach. 

The committee had been considering 
health-care-for-the-aged legislation intermit- 
tently for more than a year. Hearings were 
held on the Forand bill last summer but 
action was postponed until this year. 
(CONTINUED ON PAGE 312) 



BOOK REVIEWS 

Biology of the Pleuropneumonialike Or- 
ganisms. Annals of the New York Acad- 
emy of Sciences, Vol. 79, Article 10, pages 
305-758, 1960. 
This publication of the New York Academy of 
Sciences emphasizes the increasing- interest in the 
pleuropneumonia group of organisms which here- 
tofore have been of primary concern to taxonom- 
ists and veterinary bacteriologists. 

Contributions by 80 authors cover the present 
state of knowledge concerning the morphology, 
classification, isolation, cultivation, physiology, 
serology, chemotherapy, and pathogenicity of the 
pleuropneumonia group of organisms. It is fair to 
say that more questions are raised than are an- 
swered, but this only serves to indicate the need 
for further investigations. 

The important question of the pathogenicity of 
the pleuropneumonia organisms for humans is not 
completely answered. The isolation of PPLO from 
approximately 70 per cent of more than 500 cases 
of primary and recurrent nongonococcal urethritis 
by Shepard would indicate more than a casual re- 
lationship. Similar results have been obtained by 
others when studying women with pelvic inflam- 
matory disease and patients with acute hemor- 
rhagic cystitis. The pathogenic capabilities are 
not clear-cut, however, since PPLO can be isolated 
from the genitourinary tracts of supposedly 
normal males and females. As Dr. H. E. Morton 
states on page 613: "Trying to relate PPLO to 
disease is very difficult. However, when PPLO are 
isolated in pure culture from the genito-urinary 
tract in which there is pathology, and antibiotics 
are given, and when, in 1 to 3 days the PPLO dis- 
appear and the clinical symptoms begin to sub- 
side, this is good circumstantial evidence that 
PPLO were causing the pathology." Studies on 



::io 



NORTH CAROLINA MEDICAL JOURNAL 



July, 19(30 



PPLO-caused avian diseases have indicated that 
a superimposed physiological stress may be a re- 
quirement for the production of the disease state. 
In addition to these important problems, the re- 
lationship of PPLO and L forms of bacteria is 
discussed. Of interest to those who are utilizing 
tissue culture techniques in their research are the 
discussions of the frequent contamination of cell 
lines with PPLO. 



This monograph will be especially useful to the 
worker engaged in research in infectious diseases 
and to the practitioner who is inquisitive about 
current viral research and concepts. 



Radiopaque Diagnostic Agents. Annals of 

New York Academy of Sciences, Vol. 71, 
Article 3, pages 705-1020, 1959. 

This colloquium presents an extensive survey of 
the past, present and possible future of radio- 
graphic media. The first series of articles discuss 
the historical development and the chemical and 
pharmacologic properties of the common, pi-esent- 
day media. Four articles describe experimental 
work in animals with heavy metal chelates and 
colloidal dispersions used as contrast agents. The 
initial results were mixed and somewhat disap- 
pointing. Excellent reviews of lymphadenography, 
splenoportography with liver visualization, pan- 
creatography, and radioisotopic liver and kidney 
up-take studies are included. 

Various clinical and technical aspects of modern 
angiography are presented. Dr. J. Stauffer Leh- 
man's evaluation of high concentrations of dia- 
trizoate methyg^ucamine in angiography is par- 
ticularly worthy of note. The effect of tempera- 
ture, pre sure, and catheter size on speed of de- 
livery of the commonly available medin is de- 
scribed in two succinct graphs. 

The last group of four articles deals with the 
water soluble gastrointestinal contrast agents and 
the newer contrast agent; for examination of the 
genitourinary tract in a general fashion, citing 
extensive clinical experience. 



Virus Virulence and Pathogenicity. Ciba 
Foundation Study Group No. 4. Edited by 
G. E. N. Wolstenholme and Cecilia M. 
O'Connor. Boston: Pubished by Little, 
Brown, and Company, 1960. 
During the past decade tremendous strides have 
been made in our understanding of viruses and 
their effects on the human host. From time to time 
interested investigators must meet and discuss 
problems of a general nature about which we know 
less than is desirable. In the present monograph, 
some of the leading virologists in the world met 
to discuss the concept of virulence and pathogen- 
icity of viruses. 

In the introduction, pathogenicity is defined "as 
the power to produce pathological affects in a host, 
and virulence as the evidence of pathogenicity de- 
rived from observation of the symptoms and 
signs, degree of illness or death of the host." 

During the course of the conference various 
host-cell factors and human volunteer studies were 
discussed. 



A History of Neurology. By Walther 
Rieser, M.D. 223 pages. Price, $4.00. New- 
York: MD Publications, 1959. 

The author begins his discussion of neurology 
and its history with a consideration of various 
functions of the nervous systems. The precedence 
of structure to determine function, or function to 
determine structure, is discussed at great length 
in a somewhat theologic fashion. In like manner, 
the platonic and other doctrines regarding the 
soul are related to progress in neurology. Finally, 
various philosophic concepts of cerebral localiza- 
tion are presented. 

Only passing mention is given to specific men 
and important developments in neurology. Brief 
reference is made to the development of ideas in 
the treatment of neurologic disorders. 

The book is printed neatly, free from typographic 
errors, well indexed, and reasonably priced. 

Although of interest to one concerned with the 
evolution of philosophic concepts in neurology, 
only the author's approach is presented. The book 
would not serve as a source of reference. 



Women and Fatigue by Marion Hilliard, 
M.D., 175 pp., price $2.95, New York: 
Doubleday and Company, Inc., 1960. 
Women and Fatigue, a posthumous sequel to the 
excellent A Woman Doctor Looks at Love and Mar- 
riage, is both a source book for physicians whose 
women patients ask, "Doctor, why am I so tired?", 
and a manual of suggestions for such patients. 
Chapter titles, such as "Fatigue Has Many 
Faces", "Common Sense and Calories", and "The 
Fallacy of the Shortcut to Vitality", indicate the 
practical nature of the author's approach; while 
titles such as "A Time To Be Born and a Time To 
Die" and "Love God and Do As You Please" are a 
guide to her philosophy. The simplicity of this 
approach is, however, an insufficient indication of 
the profundity of the thought and the breadth of 
experience in helping women patients conquer 
fatigue problems that is revealed in this small 
volume. 

Zest for living, throughout the entire life's 
period is possible for women of all ages, married 
or single, is the thesis which runs throughout this 
book. Such zest comes from entering with verve 
every open door that offers a genuine opportunity 
As there is a time to be born and a time to die, so, 
too, there is a time to be young and helpless, and 
a time for growing up; a time for falling in love; 
a time for growing older. Through meeting all ex- 
periences of joy, suffering, sorrow, contentment, 
achievement, and disappointment, the self develops 
into a mature person in step with chronological 
age. 



July, 1960 



BOOK REVIEWS 



311 



It was this reviewer's privilege to have our 
second baby delivered by Dr. Hilliard. She was 
not only herself a vital person, but one became 
aware that through contact one's own revitaliza- 
tion was taking place. Dr. Hilliard never married, 
so she knew from personal experience the pro- 
blems of the single woman in American society. 
She looked at these unblinkingly, and supported 
herself by such humor as "When night falls after 
a long day of seeing patients, I sometimes have a 
fanciful vision: all the married women are bitter- 
ly thinking up ways to avoid making love, and all 
the unmarried women are just dying to get at it" 
(page 108). 

Dr. Hilliard lived for a "cause": to get women 
to work out an intellectual attack on their fatigue 
problems, and by overcoming them benefit family, 
friends, neighbors and community. Physicians, 
married or unmarried, male or female, will find 
themselves using this book to review and evaluate 
their own ways of treating patients who are bored, 
lonely, unable to love or to make love, the gen- 
uinely overworked, the secretly fearful or guilty, 
and the uncertain. 



The Story of Dissection. By Jack Kevor- 
kian, M.D., New York: Philosphical Li- 
brary. 1959. 

The author has neglected no period from ear- 
liest history to the beginning of the twentieth 
century in his anatomic considerations. In a very 
small volume a wealth of information has been 
presented, which makes not only engrossing read- 
ing, but serves as a valuable addition to reference 
material. 

A sincere attempt has been made to explain the 
progress, or lack of progress, not only in dissec- 
tion and the anatomical knowledge derived, but in 
medical science in general, in the light of existing 
conditions and opinions of each successive era. It 
is only to be regretted that more lengthy discus- 
sions could not have been included in this survey. 
Finally, the author is to be congratulated on the 
excellence of his composition and style. 



The Teen-Age Years: A Medical Guide for 
Young People and Their Parents. By 
Arthur Roth, M.D. 288 pages. Price, $3.75. 
New York: Doubleday & Company, 1960. 

This book is the result of six years of exper- 
ience on the part of the author as founder-director 
of the Teen-age Clinic at the Kaiser Foundation 
Medical Center in Oakland, California. It deals 



specifically with medical problems of the adoles- 
cent. Among the topics discussed are problems of 
sexual maturing, skin care and grooming, ortho- 
pedic problems, and the vague ailments — "aches" 
and "tiredness" — common to young people. Dr. 
Roth also explores the standards of normalcy in 
adolescence and explodes what he calls "the false 
cult of the average": the teen-ager's acute worry 
that he is too tall, too short, too anything 
that is not "normal." 

Dr. Roth received his M.D. degree from Western 
Reserve University and served his internship and 
pediatric residence in California and at Boston 
Children's Medical Center. The staff of his teen- 
age clinic at Oakland now numbers nine, and the 
case load has climbed from 25 to nearly 500 
monthly. 



Biological Stains — A Cross Index 
A new technical reference booklet dealing with 
the uses of Biological Stains has been published 
by Allied Chemical's National Aniline Division. 

The 12-page booklet cross-indexes an alphabetic- 
al listing of the principal uses of Certified Biolog- 
ical Stains and Biological Stains supplied by Na- 
tional Aniline, grouped according to the field in 
which the stains are used. 

Since all biological stains certified by the Bio- 
logical Stain Commission are obtainable from Na- 
tional Aniline, this comprehensive cross-index 
serves as a reference aid to the student of labor- 
atory technology, the established laboratory tech- 
nician and those engaged in general scientific re- 
search. 

Copies of the booklet. "Biological Stains — A 
Cross Index," are available from Allied Chemical's 
National Aniline Division, 40 Rector Street, New 
York 6, New York. 



Mead Johnson Announces New Hay Fever Drug 

A new anti-allergic drug that protects the user 
against a wide range of allergic symptoms and 
itching for up to 12 hours on a single dose was 
announced at the American Medical Association's 
annual meeting recently. 

The new agent is methdilazine hydrochloride. It 
was developed by Mead Johnson & Company of 
Evansville, Indiana, and is being marketed under 
the tradename Tacaryl. It is being introduced na- 
tionally simultaneously with the A.M. A. meeting 
announcement. 

Tacaryl is available at drug stores on a doctor's 
prescription. It is being marketed as 8 mg. scored 
tablets in bottles of 100, and as a fruit-flavored 
syrup in 16 oz. bottles. Usual daily dosage is one 
tablet or two teaspoonfuls of syrup twice daily 
for adults, and one-half tablet or one teaspoonful 
syrup twice daily for children. 



312 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



! 



3n ilnnonam 

William Wills Green, M.D. 

William Wills Green was born on July 29, 1885, 
in Franklin County, North Carolina and was edu- 
cated in the schools of that community, Horner's 
Military Academy, and the University of North 
Carolina, being graduated in 1908. He began the 
practice of medicine and surgery in Tarboro in 
1910 and remained active until one month before 
his death on March 12, 1960 The only interruption 
in his practice was for service in the Army Med- 
ical Corps in World War I with the rank of Major. 
He was an active member of the County, District, 
and State Medical Societies and the American 
Medical Associaion for 50 years, and was a past 
president of the Edgecombe-Nash Medical Society. 
He was a member of the American College of Sur- 
geons. He was an active member of the Howard 
Memorial Presbyterian Church of Tarboro and the 
Tarboro Rotary Club. 

The death of Dr. Green has removed from us 
one of our most beloved and outstanding citizens. 
He loved people and in turn was loved by them. 
One had only to view the great mass of flowers 
and the crowd at his final rites to know that here 
indeed was a friend of man. 

Dr. Green contributed of his time and talents in 
many ways for the betterment of Tarboro and 
Edgecombe Couny. Not only did he give of his 
outstanding professional skill to all, without re- 
gard to color or creed, social or financial standing, 
but he was always ready to help with anything 
that represented improvement and advancement for 
his fellow man. For 25 years he was chairman of 
the Edgecombe County Board of Education and un- 
doubtedly to him goes a large share of the credit 
for our splendid school system He worked tire- 
lessly to raise money for improvement of the phy- 
sical equipment and lived to realize his dream of 
seeing the one-room school house replaced by 
modern schools. 

Several years ago when it became apparent that 
the existing local hospital facilities were inadequate. 
Dr. Green again gave his time and ability in help- 
ing plan a new hospital and worked hard and long 
in promoting the passage of a bond issue neces- 
sary for the construction of the new Edgecombe 
General Hospital. For 26 years he was Chief of 
Staff of the old hospital, a position he held in the 
new one at the time of his death. 

A small insight into the character of this truly 
great man can be gotten from the fact that when 
the Tarboro Little League was formed. Dr. Green 
assumed the position of co-chairman of the finance 
committee, and each year personally went to bus- 
iness firms and individuals and solicited much of 
the money. Therefore 



Be it resolved: That the Edgecombe-Nash Med- 
ical Society has lost a valuable member and each 
of us a true friend; and that we, the members of 
the Edgecombe-Nash Medical Society express our 
deep sorrow and extend sympathy to his family; 
and that a copy of these resolutions be placed in 
the permanent files of this Society, a copy be sent 
to his family, and a copy be sent to the North 
Carolina Medical Journal. 

W. K. McDowell, M.D. 

A. C. Norfleet, M.D. 



The Month am WasMaigtom 

(CONTINUED FROM PAGE 309) 

Prior to approving the Mills plan, the 
committee rejected the Forand bill (three 
times) and the Eisenhower Administra- 
tion's far-reaching public assistance altern- 
ative. Both plans were opposed by the med- 
ical profession and allied groups. 

While these legislative proposals were in 
the limelight, a little-noticed bill was en- 
acted into law to give $50 million in relief 
to taxpayers burdened with taking care of 
ill dependent parents. 

The new law permits taxpayers full de- 
duction on federal income taxes for medical 
and dental expenses paid for a dependent 
parent 65 years of age and older. Previous- 
ly, such a deduction was limited to costs in 
excess of three per cent of the taxpayer's 
adjusted gross income. 

Changes in the Social Security program 
called for in the catch-all bill approved by 
the Ways and Means Committee would : 

1. Eliminate the requirement that a dis- 
abled person must be at least 50 years old 
to be eligible for Social Security benefits. 

2. Provide Social Security benefits for 
about 25,000 widows of workers who died 
before 1940. 

3. Increase the benefits of 400,000 surviv- 
ing children of workers covered by Social 
Security. 

Although all these revisions will increase 
costs of the program, neither the Social 
Security tax rate nor tax base was in- 
creased. 

The revisions will mark the fifth conse- 
cutive year of a national election that the 
Social Security program, originally enacted 
in 1935, has been expanded. Some of the 
expansions have been accompanied by tax 
increases. 



when you see 
signs of 
anxiety-tension 

specify 




dihydrochloride 



brand of thiopropazate dihydrochloride 

for rapid relief of anxiety manifestations 






■" 2? * */* * 



You will find Dartal outstandingly beneficial 
in management of the anxiety -tension states 
so frequent in hypertensive or menopausal 
patients. And Dartal is particularly useful 
in the treatment of anxiety associated with 
cardiovascular or gastrointestinal disease, or 
the tension experienced by the obese patient 
on restricted diet. You can expect consistent 
results with Dartal in general office practice. 



with low dosage: Only one 2, 5 or 10 mg. tablet 
t.i.d. with relative safety: Evidence indicates Dartal 
is not icterogenic. 

Clinical reports on Dartal: 1. Edisen, C. B., and Samuels, 
A. S.: A.M.A. Arch. Neurol. & Psychiat. 80:481 (Oct.) 1958. 

2. Ferrand, P. T.: Minnesota Med. 41:853 (Dec.) 1958. 

3. Mathews, F. P.: Am. J. Psychiat. 114:1034 (May) 1958. 



SEARLE 



v : 



XXXVI 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1900 




m 




whenever there is inflammation, 
swelling, pain 

VARIDASE 

6TREirrOKINASE-STREPTOOOBNA3E LEOEOLE 

BUCCAL™^ 

conditions for a 
fast comeback . . . 




5 days of classic therapy after 48 hours of VARIDASE 

as in cellulitis* 

Until Varidase stemmed infection, 
inflammation, swelling and pain, neithe - 
medication nor incision and drainage 
had affected the increasing cellulitis. 

Varidase mobilizes the natural healing 
process, by accelerating fibrinolysis, to 
condition the patient for successful primary 
therapy. Increases the penetrability of the 
fibrin wall, for easy access by antibodies 
and drugs . . . without destroying limiting 
membrane . . . and limits infiltration. 
Prescribe Varidase Buccal Tablets routinely 
in infection or injury. 

*lnnerfield. I.: Clinical report cited with permission. 

Varidase Buccal Tablets contain: 

10.OIIO Units Streptokinase, 2.">00 Units Streptodornase. 

Supplied: Boxes of 24 and 100 tablets 

LEDERLE LABORATORIES, 

A Division of American Cyanamid Company, Pearl River, N. Y. 



July, 1960 



ADVERTISEMENTS 



XXXVII 



AN AMES CLINIQUICr 

CLINICAL BRIEFS FOR MODERN PRACTICE 






'-• 






WHAT 

LABORATORY 

PROCEDURES 

ARE INDICATED IN 

DIABETICS WITH 

URINARY TRACT 

INFECTIONS? 



A urine culture is absolutely essential in the diabetic suspected of having a urinary tract infec- 
tion since such infection is not always accompanied by pyuria. It is also essential to keep the 
urine free from sugar— as shown by frequent urine-sugar tests— for successful therapy. 

Source: Harrison, T. R., el at.: Principles of Internal Medicine, ed. 3, New York, McGraw-Hill Book Co., 1958, p. 620. 



the most effective method of routine testing for glycosuria, 
color-calibrated 




L i ITEST 

«"""> Reagent Tablets 

the standardized urine-sugar test for reliable quantitative estimations 

Urinary tract infections are about four times more frequent in the diabetic than in 
the non-diabetic. The prevention and treatment of urinary tract infections, as well as 
the avoidance of other complications of diabetes, are significantly more effective in the 
well-controlled diabetic. The patient should be impressed repeatedly with the importance 
of continued daily urine-sugar testing— especially during intercurrent illness— and warned 
of the consequences of relaxed vigilance. 

"lirine-SUgar profile" With the new Graphic Analysis Record included in the Clinitest 

Urine-Sugar Analysis Set (and in the tablet refills), daily urine-sugar readings may be recorded to 
form a graphic portrayal of glucose excretion most useful in clinical control. ^^^^^eaaeo 

• motivates patient cooperation through everyday use of Analysis Record 

• reveals at a glance day-to-day trends and degree of control 

• provides a standardized color scale with a complete range in the familiar blue-to 
orange spectrum 



guard against ketoacidosis 

...test for ketonuria 

for patient and physician use 



ADDED SAFETY FOR DIABETIC CHILDREN 

ACETESF KET0STIX @ 

Reagent Tablets Reagent Stripy 



AMES 

COMPANY. INC 

Elkhart • Indiana 
Toronto • Canada 



f A? 



XXXVIII 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



The choice of confidence... 




diagnostic x-ray equipment 
planned for private practice! 



Few who purchase x-ray equipment have 
time to thoroughly test the quality of mate- 
rials, workmanship and technical perform- 
ance offered by all the makes of x-ray units. 
And happily this is not necessary. 

The manufacturer's reputation is worth 
more than anything else to you in choosing 
x-ray equipment, one of the most complex 
professional investments you will ever face. 

General Electric has created "just what 
the doctor ordered" in the 200-ma Patrician, 
in terms of both reasonable cost and operat- 
ing qualities. Here diagnostic x-ray is ideally 



tailored to private practice. Patrician pro- 
vides everything you need for radiography 
and fluoroscopy — and with consistent end 
results, since precise radiographic calibration 
is as much a part of the Patrician combina- 
tion as it is of our most elaborate installa- 
tions. For complete details contact your G-E 
x-ray representative listed below. 

Thgress Is Our Most Important Product 

general!! electric 



Direct Factory Branch 
CHARLOTTE 

1140 Elizabeth Ave. 
FR 6-1531 



NORTH CAROLINA 

Resident Representatives 
WILSON 

A. L. Harvey 

1501 Branch St. • Phone 23 7-2440 

WINSTON-SALEM 

N. E. Bolick 
1218 Miller St. • Phone PArk 4-5864 



July, 1960 



ADVERTISEMENTS 



XXXIX 



Ar 

the i(| 
site 1 

of 


— ., : , 



Following determination 
of basal secretion, 
intragastric pH was 
continuously determined 
by means of frequent 
readings over a 
two-hour period. 



peptic 
ulcer 



P H Data based on pH measurements in 11 patients with peptic ulcer 1 





1.5 



Neutralization 
with standard 
aluminum hydroxide 



neutralization 
is much 
faster and 
twice 
as long 
with 



60 



Ma " CREAMALIN AN1BC, ° 




LABORATORIES ! 
New York 18, N. Y, 



TABLETS 



New proof in vivo" of the much greater efficacy of new Creamalin 
tablets over standard aluminum hydroxide has now been ob- 
tained. Results of comparative tests on patients with peptic ulcer, 
measured by an intragastric pH electrode, show that newCreamalin 
neutralizes acid from 40 to 65 per cent faster than the standard 
preparation. This neutralization (pH 3.5 or above) is maintained 
for approximately one hour longer. 

New Creamalin provides virtually the same effects as a liquid 
antacid 2 with the convenience of a tablet. 
Nonconstipating and pleasant-tasting, new Creamalin antacid 
tablets will not produce "acid rebound" or alkalosis. 
Each new Creamalin antacid tablet contains 320 mg. of specially 
processed, highly reactive, short polymer dried aluminum hy- 
droxide gel (stabilized with hexitol) with 75 mg. of magnesium 
hydroxide. Minute particles of the powder offer a vastly increased 
surface area for quicker and more complete acid neutralization. 

Dosage: Gastric hyperacidity -from 2 to 4 tablets as necessary. Peptic 
ulcer or gastritis - from 2 to 4 tablets every two to four hours. Tablets may 
be chewed swallowed whole with water or milk, or allowed to dissolve 
in the mouth. How supplied: Bottles of 50, 100, 200 and 1000. 
1. Data in the files of the Department of Medical Research, Winthrop 
Laboratories. 2. Hinkel, E. T., Jr.; Fisher, M. P., and Tainter, M. L.: J. Am. 
Pharm. A. (Sclent. Ed.) 48:384, July, 1959. 

for peptic ulcer H gastritis ■gastric hyperacidity 






XL 



NORTH CAROLINA MEDICAL JOURNAL 



July. l''-0 



Diagnostic 

Quandaries 

Colitis? Gall Bladder Disease? 

Chronic Appendicitis ? 

Rheumatoid A rthritis ? Regional Enteritis ? 




W Wi DISEASE that is frequently 
■ A V overlooked in solving diag- 
"fll ' nostic quandaries is amebiasis. 
■■Hi 1 Its symptoms are varied and 
contradictory, and diagnosis is extremely 
difficult. In one study, 56% of the cases 
would have been overlooked if the routine 
three stool specimens had been relied on. 1 

Another study found 96% of a group 
of 150 patients with rheumatoid arthritis 
were infected by E. histolytica. In 15 of 
these subjects, nine stool specimens were 
required to establish the diagnosis. 2 

Webster discovered amebic infection in 
147 cases with prior diagnoses of spastic 
colon, psychoneurosis, gall bladder dis- 
ease, nervous indigestion, chronic appen- 
dicitis, and other diseases. Duration of 
symptoms varied from one week to over 
30 years. In some cases, it took as many 
as six stool specimens to establish the 
diagnosis of amebiasis. 3 

Now treatment with Glarubin provides 
a means of differential diagnosis in sus- 
pected cases of amebiasis. Glarubin, a 
crystalline glycoside obtained from the 
fruit of Simarouba glauca, is a safe, effec- 
tive amebicide. It contains no arsenic, 
bismuth, or iodine. Its virtual freedom 
from toxicity makes it practical to treat 



suspected cases without undertaking dif- 
ficult, and frequently undependable, stool 
analyses. Marked improvement following 
administration of Glarubin indicates path- 
ologically significant amebic infection. 

Glarubin is administered orally in tablet 
form and does not require strict medical 
supervision or hospitalization. Extensive 
clinical trials prove it highly effective in 
intestinal amebiasis. 

Glarubin* 

TABLETS 

specific for intestinal amebiasis 

Supplied in bottles of 40 tablets, each 
tablet containing 50 mg. of glaucarubin. 

Write for descriptive literature, bibli- 
ography, and dosage schedules. 

!. Cook, JE., P-riccs, C. \V , and Hlndley. F.W.: Chronic Ame- 
bfasis and Ihe Need Tor a Diagnostic Prolile. Am. Pract and Die 
ol Treat. ff:1821 (Dec , 1955). 

2. Rlnehart, K. E„ and Marcus, H : Incidence of Amebiasis in 
Healthy Individuals, clinic Patients and Tliose with Rheumatoid 
Arthritis. Northwest Med.. o^:70S (July, 1955). 

3. Webster. B.H.: Amebiasis, a Disease of Multiple Manifesta- 
tions. Am. Pract. and Dig. of Treat. S:S97 (June. 195S). 

•U.S. Pat. N8. 2.S64.745 

THE S.E. |y|ASSENGILL COMPANY 



NEW YORK 



BRISTOL, TENNESSEE 
KANSAS CITY 



SAN FRANCISCO 



July, 1960 



ADVERTISEMENTS 



IN CONTRACEPTION... 



XLI 
~1 




WHY IS SPEEDIER SPERMICIDAL ACTION IMPORTANT? 

Because a swift-acting spermicide best meets the variables of spermatozoan activity. 



Lanesta Gel, ". . . found to immobilize human sper- 
matozoa in one-third to one-eighth the time required 
by five of the leading contraceptive products currently 
available . . ."* thus provides the extra margin of 
assurance in conception control. The accelerated 
action of Lanesta Gel — it kills sperm in minutes in- 
stead of hours — may well mean the difference 
between success and failure. 

•Berberian, D. A., and Slighter, R. G.: JAMA. 168:2257 
(Dec. 27) 1958. 

In Lanesta Gel 7 -chloro-4-indanol, a new, effective, 
nonirritating, nonallergenic spermicide produces im- 
mediate immobilization of spermatozoa in dilution 
of up to 1:4,000. Spermicidal action is greatly accel- 



erated by the addition of 10% NaCl in ionic form. 
Ricinoleic acid facilitates the rapid inactivation and 
immobilization of spermatozoa and sodium lauryl 
sulfate acts as a dispersing agent and spermicidal 
detergent. 

Lanesta Gel with a diaphragm provides one of the 
most effective means of conception control. 
However, whether used with or without a 
diaphragm, the patient and you, doctor, can 
be certain that Lanesta Gel provides .faster 
spermicidal action — plus essential diffusion 
and retention of the spermicidal agents in 
a position where they can act upon the 
spermatozoa. 



t-ii 

■ . . 



Lanesta Gel 

Supplied: Lanesta Exquiset . . . with diaphragm of prescribed size and type; universal introducer; \ f^ DfOdllCt 

Lanesta Gel, 3 oz. tube, with easy clean applicator, in an attractive purse. Lanesta Gel, 3 oz. tube with ] x I antefin® 

applicator; 3 oz. refill tube — available at all pharmacies. ; , 

Manufactured by Esta Medical Laboratories, Inc., Alliance, Ohio Distributed by George A, Breon & Co., New York 18, N Y. <,... " : . 



XLII 



NORTH CAROLINA MEDICAL JOURNAL 



July, l'.-'O 













I 



J 



no irritating crystals • uniform concentration in each drop" 
STERILE OPHTHALMIC SOLUTION 

NEO HYDELTRASOL 



2,000 TIMES MORE SOLUBLE THAN 

"The solution of prednisolone has the 

advantage over the suspension in that no 

crystalline residue is left in the patient's 

cul-de-sac or in his lashes .... The other 

advantage is that the patient does not have to 

shake the drops and is therefore sure of 

receiving a consistent dosage in each drop." 2 



PREDNISOLONE 2\- PHOSPHATE-NEOMYCIN SULFATE 

PREDNISOLONE OR HYDROCORTISONE 

1. Lippmann. 0.: Arch Ophth. 57:339. March 1957. 

2. Gordon, D.M.: Am. J. Ophth. 46:740. November 1958. 
supplied: 0.5% Sterile Ophthalmic Solution NEO- 
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile 
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc 
dropper vials Also available as 0.25% Ophthalmic 
Ointment NEO-HYDELTRASOL (with neomycin sulfate) 
and 0.25% Ophthalmic Ointment HYDELTRASOL. 
In 3.5 Gm. tubes 



HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck S Co.. Inc. 
^m MERCK SHARP & DOHME Division of Merck & Co, Inc.. Philadelphia 1. Pa. 






XLIII 




ORIGINAL FORMULA 

The ideal cerebral tonic and stimulant for the aged. 



NICOZOL therapy (the original formula) affords 
prompt relief of apathy. Patients generally look 
better, feel better; become more cooperative, 
cheerful and easier to manage. 
No dangerous side effects. 



NICOZOL contains pentylenetetrazol 
and nicotinic acid 

For relief of agitation and hostility: 
NICOZOL with reserpine Tablets 

Supply: Capsules • Elixir 



Write for professional sample and literature. 



see 
Page 666 



DRUG 

C^jj^ff^f^ WINSTON-SALEM 1, NORTH CAROLINA 



XLIV 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



l'AGrs. Ea. 
FLAVORED 



I 

Living up to 
a family tradition 



There are probably certain medications which are 
special favorites of yours, medications in which 
you have a particular confidence. 

Physicians, through ever increasing recommen- 
dation, have long demonstrated their confidence 
in the uniformity, potency and purity of Bayer 
Aspirin, the world's first aspirin. 

And like Bayer Aspirin, Bayer Aspirin for Chil- 
dren is quality controlled. No other maker submits 
aspirin to such thorough quality controls as does 
Bayer. This assures uniform excellence in both 
forms of Bayer Aspirin. 

You can depend on Bayer Aspirin for Children 
for it has been conscientiously formulated to be 
the best tasting aspirin ever made and to live up 
to the Bayer family tradition of providing the finest 
aspirin the world has ever known. 

Bayer Aspirin for Children- IVi grain flavored 
tablets-Supplied in bottles of 50. 

• We welcome your requests for samples on Bayer 
Aspirin and Flavored Bayer Aspirin for Children. 



GRIP-TIGHT CAP 
for Children's 
Greater Protection 



""•mix "wi m*V* 

W BAYER 

11 ASPIRIN \ 

^CHILDREN 




THE BAYER COMPANY. DIVISION OF STERLING QRUG INC.. 1450 BROADWAY. NEW YORK 18. N. Y. 






July, 1960 



ADVERTISEMENTS 



XLV 



in arthritis and allied 
disorders 


Butazolidin" 

brand of phenylbutazone 

Geigy 

Since its anti-inflammatory properties 
were first noted in Geigy laboratories 10 
years ago, time and experience have 
steadily fortified the position of 
Butazolidin as a leading nonhormonal 
anti-arthritic agent. Indicated in. both 
chronic and acute forms of arthritis, 
Butazolidin is noted for its striking 
effectiveness in relieving pain, 
increasing mobility and halting 
inflammatory change. 




Proved by a Decade of Experience 
Confirmed by 1700 Published Reports 
Attested by World-Wide Usage 


Butazolidin®, brand of phenylbutazone: 
Red, sugar-coated tablets of 100 mg. 
Butazolidin® Alka: Orange and white 
capsules containing Butazolidin 100 mg.; 
dried aluminum hydroxide gel 100 mg.; 
magnesium trisilicate 150 mg.; 
homatropine methylbromide 1.25 mg, 

Geigy, Ardsley, New York wjgf 


-• ' 'ffllBPBK'flnPtiiFr*i ^t.. 


1 wA ""*"- -^ : /*m^m 


^\ \j 



162-60 



XLVI 



NORTH CAROLINA MEDICAL JOURNAL 



July, I960 



\ 



. 



for treatment of 



Peptic Ulcers 
and Hyperacidity 
















Brand of Hyamagnate 



... 



Neutralizes excess acidity 
Sustains acid-base balance 



Glycamine Is a New Chemical Compound 

— not a mixture of alkalis — that re-establishes nor- 
mal digestion without affecting enzymatic activity. 
Glycamine's CONTROLLED ACTION does not 
stimulate acid secretion or alkalosis. 

NON-SYSTEMIC Glycamine is compatible with 
antispasmodics and anticholinergics. 




Pn&tiytibe 



GLYi \>II.\E TABLETS \>M I.IIM III 

Available in bottles of lOO. 500 
and lOOO tablets; or pints. 




Loic dosage 
prorides prompt 
long lasting relief 

• Only four pleasant 

tasting, chew-up 

tablets or four 

teaspoonfuls needed 

dally. Each dosage 

maintains optimum 

pH for 4'A hours. 



PHARMACEUTICALS 



May ran 1 1 



me. 

Greensboro, North Carolina 



July, 1960 



ADVERTISEMENTS 



XLVII 



HELP US KEEP THE 
THINGS WORTH KEEPING 




It's good to be a boy, exploring the 
wide world, soaking up wonderful 
new sounds and sights everywhere 
you go. And if the world's a peaceful 
place, it's good to grow up, too, and 
become a man. 

But will the world stay peaceful? 
That depends on whether we can keep 
the peace. Peace costs money. 

Money for military strength and 



for science. And money saved by 
individuals to help keep our economy 
strong. 

Your Savings Bonds make you a 
Partner in strengthening America's 
Peace Power. 

The Bonds you buy will earn good 
interest for you. But the most im- 
portant thing they earn is peace. 
Are you buying enough? 

HELP STRENGTHEN AMERICA'S PEACE POWER 

BUY U. S. SAVINGS BONDS 

The U.S. Government does not pay for this advertising. The Treasury Department thanks 
The Advertising Council and this magazine for their patriotic donation. 



VW 



4 1-2x6 1-2 in. 100 Screen SBD-GM-59-12 



XLVIII 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 




A Vacation from Hay Fever 
is a Real Vacation 

ANYWHERE - ANYTIME 

Just a "poof" of fine nTz spray 

brings relief in seconds , for hours 



NlZ is a potentiated, balanced 
combination of these well known 
synergistic compounds : 
Neo-Synephrine® HC1, 0.5% 

- dependable vasoconstrictor 
and decongestant. 

Thenfadil® HC1, 0.1% 

- potent topical 
antihistaminic. 

Zephiran® CI, 1:5000 

- antibacterial wetting 
agent and preservative. 




NASAL SPRAY 



Supplied in leakproof,-^^ s 

pocket size o^x 

squeeze bottles of 20 cc. "^ ^ 



UUn/tOp IABORATOHIES >vj 

I Newrotk it.y I. JtM 



July, 1960 



ADVERTISEMENTS 



XLIX 




NORTH CAROLINA MEDICAL JOURNAL 



July. 19fi0 




More mileage... 



The older man in industry needs the 
help of doctor, management, and home- 
maker ... to extend his years of pro- 
ductivity. 

A recent study of presumably healthy 
men in business showed nearly one- 
third to be obese. Many suffered from 
diseases of nutritional origin or requir- 
ing special dietary treatment. 

Obesity is associated with increased 
incidence of many serious diseases . . . 
chronic illnesses occurring with about 
twice the frequency among obese indi- 
viduals 40 to 59 years of age as among 
those of normal weight. At all ages, 
more deaths occur among the obese. 
Evidence indicates obesity is becoming 
more frequent among men . . . increas- 
ing the health hazard during middle 
years. 

Mechanization of industry increases 
the value of the skilled and experienced 
worker. . .while decreasing his physical 
activity and energy needs . . . and in- 



creasing his need for choosing foods of 
high nutrient content in relation to cal- 
orie value. Milk is such a food. 

Three glasses of milk a day ... to 
drink . . used in food preparation . . . 
as cheese or ice cream . . . will provide 
all the calcium needs of men . . . and 
supply generous amounts of high qual- 
ity protein and other essential nutrients. 

In planning meals to maintain and 
extend productivity of the man in 
industry, milk and milk products are 
foundation foods for good eating and 
good health. 

The nutritional statements made by this 
advertisement have been revielted by the 
Council on Fo^ds and Nutrition of the Ameri- 
can Medical Association and jound consistent 
with current authoritative medical opinion. 

S : nce 1915 . . . promoting better health 
through nutrition, research and education. 



NATIONAL DAIRY COUNCIL 

A non-profit organization 
111 N. Canal Street • Chicago 6, 111. 




THIS ADVERTISEMENT IS ONE OF A SERIES. REPRINTS ARE AVAILABLE UPON REQUEST 



This information is reproduced in the interest of good nutrition and health by the Dairy 

Council Units in North Carolina. 

Burlington-Durham-Raleigh 

310 Health Center Bldg. 
Durham. N. C. 



High Point-Greensboro 
106 E. Northwood St. 
Greensboro, N. C. 



Winston-Salem 
610 Coliseum Drive 
Winston-Salem, N. C. 



July, 1960 



ADVERTISEMENTS 



LI 



51to49...it'saboy! 






94 to 6 BONADOXIN'stops morning sickness 



When she asks "Doctor, what will it 
be?" you can either flip a coin or point 
out that 51.25% births are male. 1 But 
when she mentions morning sickness, 
your course is clear: bonadoxin. 

For, in a series of 766 cases of morning 
sickness, seven investigators report ex- 
cellent to good results in 94 %. 2 More 
than 60 million of these tiny tablets 
have been taken. The formula: 25 mg. 
Meclizine HC1 (for antinauseant ac- 
tion) and 50 mg. Pyridoxine HC1 (for 



metabolic replacement). Just one tablet 
the night before is usually enough. 

bonadoxin — drops and Tablets— are 
also effective in infant colic, motion 
sickness, labyrinthitis, Meniere's syn- 
drome and for relieving the nausea and 
vomiting associated with anesthesia and 
radiation sickness. See pdr p. 795. 

1. Projection from Vital Statistics, U.S. Govern- 
ment Dept. HEW, Vol. 48, No. 14, 1958, p. 398. 

2. Modell. W. : Drugs of Choice 1958-1959, St. Louis, 
C. V. Mosby Company, 1958, p. 347, 




New York 17, New York 
Division. Chas. Pfizer & Co., Inc. 
Science for the World's Well-Being 



LII 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



"TMh 




whenever depression 
complicates the picture 



In many seemingly mild physical disorders 
an element of depression plays an 
insidious etiologic or complicating role. 

Because of its efficacy as an antidepres- 
sant, coupled with its simplicity of usage, 
Tofranil is admirably adapted to use in the 
home or office in these milder "depression- 
complicated" cases. 



Tofranil 

brand of imipramine HCI 



hastens recovery 



Geigy 



It is always wise to recognize that depres- 
sion may be an underlying factor... that 
Tofranil may speed recovery in "hypochon- 
driasis"; in convalescence when recovery 
is inexplicably prolonged; in chronic illness 
with dejection; in the menopausal patient 
whose emotional disturbances resist 
hormone therapy; and in many other com- 
parable situations in which latent depres- 
sion may play a part. 

Detailed Literature Available on Request. 

Tofranil*, brand of imipramine hydrochloride, 
tablets of 25 mg. Ampuls for intramuscular 
administration, 25 mg. in 2 cc. of solution. 



160-60 



Geigy, Ardsley, New York 



July, 1960 ADVERTISEMENTS LIH 



I Major Hospital Policy 

Pays up to $10,000.00 for each member of your family, 
subject to deductible you choose 

Deductible Plans available: 
$100.00 
$300.00 
I $500.00 



1 



: 






Business Expense Policy 

Covers your office overhead while you 
are disabled, up to $1,000.00 per month 



Write or Call 
for information 

Ralph ]. Golden Insurance Agency 



Phones: BRoadway 5-3400 BRoadway 5-5035 



I 
i. 



i j l I 

approved by I 

I 
The Medical Society of North Carolina 

for Its Members 






| 

I 

ivaipn ). ooiueii insurance regency 

f Ralph J. Golden Associates Henry Maclin, IV | 

I Harry L. Smith John Carson 

I 

108 East Northwood Street 

Across Street from Cone Hospital 

GREENSBORO, N. C. 



1 



MM 



LIV 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



whenever digitalis 
is indicated 



LANOXIN DIGOXIN 



formerly known as Digoxin 'B. W. & Co. 



v tnlis assent were 
"If one digital ag 

Ko recommended jor us 

, Le vine.S- A ' 2 J, par. Z- 
Boston. U"«- 



'LANOXIN' TABLETS 
0.25 mg. scored (white) 
0.5 mg. scored (green) 



■M 



'LANOXIN' INJECTION 
0.5 mg. in 2 cc. (I.M. or I.V.) 



'LANOXIN' ELIXIR PEDIATRIC 

0.05 mg. in 1 cc. 



URROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N.Y. 



July, 1960 



ADVERTISEMENTS 



LV 



How to be 
Carefree 
Without 
Hardly 
Trying • • • 




It really takes a load off your mind. . . 
to know that you are protected from 
loss of income due to illness or accident! 

"Dr. Carefree" has no 30-day 
sick leave ... no Workmen's 
Compensation . . . BUT he has a 
modern emergency INCOME PROTEC- 
TION PLAN with Mutual of Omaha. 

When he is totally disabled by accident or sickness covered by this plan, this plan 
will give him emergency income, free of Federal income tax, eliminating the night- 
mare caused by a long disability. 

Thousands of members of the Medical Profession are protected with Mutual of Oma- 
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the 
profession. 

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in 
touch now with the nearest General Agent, listed below. You'll get full details, with- 
out obligation. 



m 

OF OMAHj 

Largest Exclusive Health and Accident Company in the World. 




G. A. RICHARDSON, General Agent 
Winston-Salem, N. C. 



J. A. MORAN, General Agent 
Wilmington, N. C. 

J. P. GILES, General Agent 
Asheville, N. C. 



LVI 



NORTH CAROLINA MEDICAL JOURNAL 



July, 1960 



TUCKER HOSPITAL, Inc. 

212 West Franklin Street 
Richmond, Virginia 

A private hospital for diagnosis and treatment of psychiatric and neurol- 
ogical patients. 
Hospital and out-patient services. 

(Organic diseases of the nervous system, psychoneuroses, psychosomatic 
disorders, mood disturbances, social adjustment problems, involutional 
reactions and selective psychotic and alcoholic problems.) 



Dk. James Asa Shield 



Dr. Weir M. Tucker 



Dr. George S. Fultz 



Dr. Amelia G. Wood 




Protection Against Loss of Income 
from Accident & Sickness as Well as 
Hospital Expense Benefits for You and 
All Your Eligible Dependents 



All 



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60 TO 



PHYSICIANS CASUALTY & HEALTH 
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OMAHA 31, NEBRASKA 
Since 1902 

Jandsome Professional Appointment Book sent to 
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SURGICAL 
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P. O. Box 1716 Telephone 3-7616—3-7617 



July, 1960 



ADVERTISEMENTS 



LVII 





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Of special x~Cjf 

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physician /~r 

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unvarying activity and quality. . 

When the physician writes "DR" 
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assured that this "quality" tablet 
is dispensed to his patient. 

Rx Tablets Quinidine Sulfate Natural 

0.2 Gram (or 3 grains) 

Davies, Rose 

Clinical samples sent to physicians on request 

Davies, Rose St Company, Limited 
Boston 18, Mass. .. 



LVIII 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



O-way support 

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A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S. P. Units • 
Vitamin B„ with AUTRINIC"' Intrinsic Factor Concentrate 1/15 
U.S.P. Unit (Oral) • Thiamine Mononitrate (B.l 5 mg. • Ribo- 
flavin (B 2 ) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B 6 ) 
0.5 mg. • Calcium Pantothenate 5 mg. • Folic Acid 0.4 mg. • 
Choline Bitartrate 25 mg. • Inositol 25 mg. • Ascorbic Acid (C) 



as Calcium Ascorbate 50 mg. • l-Lysine Monohydrochloride 
25 mg. • Vitamin E (Tocopherol Acid Succinate) 10 Int. Units • 
Rutin 12.5 mg. • Ferrous Fumarate (Elemental iron. 10 mg.) 
30.4 mg. • Iodine (as Kl) 0.1 mg. • Calcium (as CaHP0 4 ) 35 mg. 
• Phosphorus (as CaHP0 d ) 27 mg, ■ Fluorine (as CaFj) 0.1 mg. • 
Copper (as CuO) 1 mg. • Potassium (as K,S0 4 ) 5 mg. • Manganese 
(as MnO;l 1 mg. • Zinc (as ZnO) 0.5 mg. • Magnesium (MgO) 
1 mg. • Boron (as NaAOj.lOHiO) 0.1 mg. Bottles of 100, 1000. 



LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York 




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July. 1960 



ADVERTISEMENTS 



LIX 



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For Prevention and Reversal of 

Cardiac Arrest 

The Birtcher Mobile Cardiac Monitoring and Re- 
suscitation Center* 



Cardiac Arrest is an ever present danger during 
anesthesia 



Cardiac arrest can occur during an anesthesia, even to 
patients with no prior record of cardiac disease. Contin- 
uous monitoring of every patient can prevent most 
cardiac arrests by providing advance warning. For cases 
where the accident cannot be prevented, instruments to 
reverse the arrest and restore circulation should always 
be instantly available. 

*CompTised of the Birtcher Cardioscope, EEG Pre-Amplifier, Dual 
Trace Electronic Switch, Electrocardiograph, Defibrillator and Heart- 
pacer icith all necessary attachments on a Mobile Stand as shou-n. 

Carolina Surgical Supply Company 






"The House of Friendly and Dependable Service" 

06 TUCKER ST. TEL: TEMPLE 3-8631 

RALEIGH. NORTH CAROLINA 



SAINT ALBANS 

PSYCHIATRIC HOSPITAL 

(A Non-Profit Organization) 

Radford, Virginia 



James P. 
Daniel D. Chiles, M. D. 

Clinical Director 
James K. Morrow, M. D. 
Silas R. Beatty, M. D. 



STAFF 

King, M. D., Director 

William D. Keck, M. D. 
Edward W. Gamble, III, M. 
J. William Giesen, M. D. 
Internist (Consultant) 



Clinical Psychology: 

Thomas C. Camp, Ph. D. 
Artie L. Sturgeon, Ph. D. 



Don Phillips 
Administrator 



AFFILIATED CLINICS 



Bluefield Mental Health Center 

525 Bland St., Bluefield, W. Va. 

David M. Wayne, M. D. 

Phone: DAvenport 5-9159 

Charleston Mental Health Center 

1119 Virginia St., E., Charleston, W. Va. 

B. B. Young, M. D. 

Phone: Dickens 6-7691 



Beckley Mental Health Center 

109 E. Main Street, Beckley, W. Va 

W. E. Wilkinson, M. D. 

Phone: CLifford 3-8397 

Norton Mental Health Clinic 

Norton Community Hospital, Norton 
Pierce D. Nelson, M. D. 
Phone: 218, Ext. 55 and 56 



Va. 



LX 



NORTH CAROLINA MEDICAL JOURNAL 



July. 1960 



BRAWNER'S SANITARIUM, INC, 

(Established 1910) 
2932 South Atlanta Road, Smyrna, Georgia 



FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES 
AND PROBLEMS OF ADDICTION 

MODERN FACI LITI ES 

Approved by Central Inspection Board of American Psychiatric Association 
and the Joint Committee on Accreditation 

Jas. N. Brawner, Jr., M.D. 
Medical Director 

Phone HEmlock 5-4486 



HIGHLAND HOSPITAL, INC. 

Founded In 1904 

ASHEVILLE, NORTH CAROLINA 

Affiliated with Duke University 




A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy- 
chotherapy, occupational and recreational therapy — for nervous and mental disorders. 

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North 
Carolina, affording exceptional opportunity for physical and emotional rehabilitation. 

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non- 
resident care. 



R. CHARMAN CARROLL, M.D. 
Medical Director 



ROBERT L. CRAIG, M.D. 
Associate Medical Director 



JOHN D. PATTON, M.D. 
Clinical Director 









July, 1960 



ADVERTISEMENTS 



LXI 



ASHEVILLE 



APPALACHIAN HALL 

ESTABLISHED — 1916 



NORTH CAROLINA 




An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drug 

and alcohol habituation. 

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is eauipped with complete laboratory 

facilities including electroencephalography and X-ray. 

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate 

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite. 

Wm. Ray Griffin, Jr., M.D. 
Robert A. Griffin, M.D. 



For rates and further information write 



Mark A. Griffin, Sr., M.D. 
Mark A. Griffin, Jr., M.D. 

APPALACHIAN HALL, ASHEVILLE, N. C. 




When too many tasks 

seem to crowd 

the unyielding hours, 

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LXII 



NORTH CAROLINA MEDICAL JOURNAL 



July, 19(50 



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Testosterone 2.5 mg. • d-Amphetamine Sulfate 2.5 mg. • Vitamin 
A (Acetate) 5,000 U.S. P. Units • Vitamin D 500 U.S.P. Units • 
Vitamin B, 2 with AUTRINIC ? Intrinsic Factor Concentrate 1 15 
U.S.P. Unit (Oral) • Thiamine Mononitrate (B,) 5 mg. • Ribo- 
flavin (B 2 ) 5 mg. • Niacinamide 15 mg. • Pyridoxine HCI (B 6 ) 
0.5 mg. • Calcium Pantothenate 5 mg. • Folic Acid 0.4 mg. • 
Choline Bitartrate 25 mg. • Inositol 25 mg. • Ascorbic Acid (C) 



as Calcium Ascorbate 50 mg. • l-Lysine Monohydrochloride 
25 mg. • Vitamin E (Tocopherol Acid Succinate) 10 Int. Units • 
Rutin 12.5 mg. • Ferrous Fumarate (Elemental iron, 10 mg.) 
30.4 mg. • Iodine (as Kl) 0.1 mg. • Calcium (as CaHPOJ 35 mg. 
• Phosphorus (as CaHPO.,) 27 mg. • Fluorine (as CaF,) 0.1 mg. • 
Copper (as CuOi 1 mg. • Potassium (as K;S0 4 ) 5 mg. • Manganese 
(as MnO ; ) 1 mg, • Zinc (as ZnO) 0.5 mg. ■ Magnesium (MgO) 
1 mg. • Boron (as Na 2 B.,0,.10H ; 0i 0.1 mg. Bottles of 100, 1000. 



LEDERLE LABORATORIES, a Division of AMERICAN CYANAMID COMPANY, Pearl River, New York 



July, 1960 



ADVERTISEMENTS 



LXIII 



INDEX TO ADVERTISERS 



American Casualty Insurance Company LIII 

Ames Company ..XXXVII 

Appalachian Hall LXI 

Arnar-Stone Laboratories XXIII 

Ayerst Laboratories XXVII 

Brawner's Sanitarium LX 

Brayten Pharmaceutical Company IX 

George A. Breon XLI 

Bristol Laboratories XII, XIII, XVIII, XXIV, 

XXV, XXVIII 
Burroughs-Welleome & Company XXII, LIV 

Carolina Surgical Supply Co LIX 

Coca Cola Bottling Company LXI 

Columbus Pharmacal Company XLIX 

J. L. Crumpton XXXIV 

Dairy Council of North Carolina L 

Davies, Rose & Co LVII 

Drug Specialties, Inc. XLIII 

Endo Laboratories XX 

Geigy Pharmaceutical XLV, LII 

General Electric X-Ray Dept XXXVIII 

Glenbrook Laboratories (Bayer Co.) XLIV 

Highland Hospital LX 

Hospital Saving Assn. of N. C XXXI 

Jones and Vaughan, Inc Ill 

Lederle Laboratories XXI, XXVI, XXXII, 

XXXIII, XXXVI, LVIII, LXII 
Eli Lilly & Company XXX, Front Cover 



The S. E. Massengill Company XL 

May rand, Inc XLVI 

Merck, Sharp & Dohme ... Second Cover, XLII 

Monarch Elevator and Machine Co LVIII 

Mutual of Omaha LV 

Parke, Davis & Co LXIV, Third Cover 

Physicians Casualty Association 

Physicians Health Association LVI 

Physicians Products Company XIV 

Pinebluff Sanitarium I 

Pisgah Forest Inn LVIII 

P. Lorillard Company (Kent Cigarettes) XI 

A. H. Robins Company XV 

J. B. Roerig & Company XIX, LI 

Saint Albans Sanatorium LIX 

Schering Corporation XXIX 

G. D. Searle & Co XXXV 

Smith-Dorsey Company XVI, XVII 

Smith-Kline & French Laboratories 4th Cover 

St. Paul Fire and Marine Insurance LXIII 

Tucker Hospital LVI 

U. S. Vitamin Company Reading 

Valentine Company LVII 

Wachtel's Incorporated LVI 

Wallace Laboratories VI, Insert, VII 

Wesson Oil and Snowdrift 

Sales Company IV, V 

Winchester Surgical Supply Co. 

Winchester-Ritch Co. I 

Winthrop Laboratories X, XXXIX, XLVIII 







Ury • 



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HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN. 



SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458 



one child has epilepsy... 

even her companions might not know— if 
her seizures are controlled with medication 



DILANTIN 



"...nowadays our approach should be, as far as possible, to protect 
the patient with sufficient medicine and allow him to live as much 
as possible the life of a normal child." 1 Under proper medical care, 
epileptic children may — and should - participate in the general phys- 
ical activities of their normal playmates.- 
for clinically proved results in control of seizures 

i> SODIUM KAPSEALS® outstanding performance 
in grand mal and psychomotor seizures:" In 
the last 15 years new anticonvulsant agents 
have come into clinical use but they have 
not replaced diphenylhydantoin [Dilantin] as the most effective single agent 
for a variety of reasons." 1 DILANTIN Sodium {diphenylhydantoin sodium. 
Parke-Davis) is available in several forms including Kapseals of 0.03 Gm. 
and of 0.1 Gm.. in bottles of 100 and 1.000. 

other members of THE PARKE-DAVIS FAMILY OF ANTICONVULSANTS 

for grand mal and psychomotor seizures: PHELANTIN* Kapseals (Dilantin 
100 mg., phenobarbital 30 nig., desoxyephedrine hydrochloride 2.5 mg.), 
bottles of 100' for the petit mal triad: MiLONTiN ri Kapseals, (phensuximide, 
Parke-Davis) 0.5 Gm., bottles of 100 and 1,000; Suspension, 250 mg. per 
4 cc., 16-ounce bottles. CELONTIN® Kapseals (methsuximide, Parke-Davis) 
0.3 Gm., bottles of 100. 

Literature supplying details of dosage and administration available on request . 
Bibliography: (1) Scott, J. S.. & Kellaway, P: M. Clin. North America 42:416 (March) 1958. 
(2) Ganoui?, L. D., in Green. J. R., & Steelman, H. E: Epileptic Seizures. Baltimore, Williams & 
Wilkins Company. 1956, pp. 98-102. (3) Bray, P E: Pediatrics 23:151. 1959. 26.»o 



PARKE-DAVIS 



PARKE, DAVIS & COMPANY . Detroit 32. Michican 



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IN ANXIETY-RELAXATION 
RATHER THAN DROWSINESS 



STELAZINF 



brand of trifluoperazine 



'Stelazine' has little if any soporific effect. ". . . pa- 
tients who reported drowsiness as a side effect 
mentioned that they did not fall asleep when they 
lay down tor a daytime nap. It is quite possible that, 
in some instances, 'drowsiness' was contused with 
unfamiliar feelings of relaxation." 1 

Available' tor use in everyday practice: Tablets, 
1 ing., in bottles of 50 and 500; and 2 mg., in 
bottles of 50. 

N.B.: For information on dosage, side effects, 
cautions and contraindications, sec available com- 
prehensive literature, PDR, or your S.K.F. rep- 
resentative. 



1. Goddard. E.S. : in Trifluoperazine. Further Clini- 
cal and Laboratory Studies, Philadelphia, Lea & 
Febiger, 1959. 



SMITH 
KLINE & 
FRENCH 



leaders in psychopharmacettlkal research 



NORTH CAROLINA 




IN THIS ISSUE: 



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SYMPOSIUM ON ACUTE SURGICAL CONDITION% 3 , , R 

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Pyronil® 15 mg . 

a long-acting antihistaminic 

Clopane* Hydrochloride . . 12.5 m g . 

a sympathomimetic 
Usual Dosage: 2 or 3 Pulvules daily. Also available as Suspension and Pediatric Pulvules. 



Co-Pyronil® (pyrrobutamine compound, Lilly) 

Histadyl® (thenylpyramine, Lilly) 

Pyronil® (oyrrobutamine. Lilly) 

Clopane® Hydrochloride (cyclopentamine hydrochloride, Lilly) 

ELI LILLY AND COMPANY . INDIANAPOLIS 6, INDIANA, U. S. A. 



Sfey 



Table of Contents, Page II 



CLINICAL REMISSION 

IN A "PROBLEM" ARTHRITIC 

In rheumatoid arthritis with diabetes mellitus . A 54-year-old diabetic 
with a four-year history of arthritis was started on Decadron, 0.75 mg./ 
day, to control severe symptoms. After a year of therapy with 0.5 to 
1.5 mg. daily doses of Decadron, she has had no side effects and dia- 
betes has not been exacerbated. She is in clinical remission .* 

New convenient b. i.d. alternate dosage schedule: the degree and extent of relief provided by 
DECADRON allows tor b.i.d. maintenance dosage in many patients with so-called "chronic" condi- 
tions. Acute manifestations should first be brought under control with a t.i.d. or q.i.d. schedule. 

Supplied: As 0.75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available 
as Injection DECADRON Phosphate. Additional information on DECADRON is available to physicians 
on request. DECADRON is a trademark of Merck & Co., Inc. 

•From a clinical investigator's report to Merck Sharp & Dohme. 



Decadron* 



Dexamethasone 



TREATS MORE PATIENTS MORE EFFECTIVELY 

(ffsra MERCK SHARP & DOHME • Division of Merck & Co., INC., West Point, Pa. 



I i 




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LK 



<; 



-.j 






August, 1960 



ADVERTISEMENTS 




A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous 
and Mental Diseases, Alcoholism and Drug Addiction. 

The Pinebluff Sanitarium is situated in the sandhills of North Carolina in a 60-acre park 
of long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern 
Pines. This section is unexcelled for its healthful climate. 

Ample facilities are afforded for recreational and occupational therapy, particularly out- 
of-doors. 

Special stress is laid on psychotherapy. An effort is made to help the patient arrive at 
an understanding of his problems and by adjustment to his personality difficulties or 
modification of personality traits to effect a cure or improvement in the disease. Two resident 
physicians and a limited number of patients afford individual treatment in each case. 

For further information write: 

The Pineblu££ Sanitarium, PinebiuSf, N. c. 



Malcolm D. Kemp, M.D. 



Medical Director 



RITTER ... the finest for 



the profession! 



The Ritter Universal Table enables you to treat more 
patients more thoroughly, with less effort in less time. 
Here is the ultimate in examining table flexibility . . . 
easy to position . . . more comfortable for patients. 




The L-F BasalMeter of- 
fers fast, accurate BMR 
testing. No graph, chart 
or slide rule needed. 
Patient's BM rate is 
read directly on meter. 



WINCHESTER 

"CAROLINAS' HOUSE OF SERVICE" 

WINCHESTER SURGIICAL SUPPLY CO. WINCHESTER-RITCH SURGICAL CO. 

119 East 7th Street Charlotte, N. C. 421 West Smith St. Greensboro, N. C. 







NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



North Carolina Medical Journal 

Official Organ of 
The Medical Society of the State of North Carolina 



Volume 21 
Number 8 



AUGUST, 1960 



75 CENTS A COPY 
$5.00 A YEAR 



CONTENT 



Original Articles 

Symposium on Acute Surgical Conditions of 
the Abdomen 

Acute Abdominal Pain Associated with 
Vascular Emergencies — Gordon M. Car- 
ver, Jr., M.D 313 

Diagnosis and Treatment of Intussuscep- 
tion in Infants and Children — Louis 
Shaffner, M.D 318 

Diagnosis and Treatment of Acute Diver- 
ticular Disease of the Colon — E. Jackson 
Dunning, M.D 322 

Diagnosis and Treatment of Acute Chole- 
cystitis—William W. Shingleton, M.D. . 326 

Acute Surgical Conditions Associated with 
Pelvic Endometriosis — Robert A. Ross, 
M.D 329 

Medical and Hospital Costs of the Aged — A 
Current Appraisal — Walter Polmer, Ph.D. 330 

Leptospirosis: Report of a Case — William A. 
Leonard, Jr., M.D 339 

Medical Problems Facing Congress — Sam J. 
Ervin, Jr 335 

Salmonella and Shigella Infections Found in 
One Hundred Ninety-five Cases of Acute 
Diarrhea— E. R. Caldwell, Jr., and E. A. 
Abernathy, M.D 342 

EDITORIALS 

Naming New Drugs 343 

The Arthritis Hoax 344 

Psychiatric Patients in a General Hospital . 344 

Three Corrections 344 

Dr. Preston — New Editor of Health Bulletin . 345 

"You Are Old, Father William" 345 

North Carolina's Committee on the Medical 
Credit Bureaus 345 



COMMITTEES AND ORGANIZATIONS 

North Carolina Board of Medical Examiners: 
The Biennial Registration 346 

Bulletin Board 

Coming Meetings 346 

New Members of the State Society .... 347 

News Notes from the University of North 
Carolina School of Medicine 347 

News Notes from the Bowman Gray School 
of Medicine of Wake Forest College . . . 348 

News Notes from the Duke Uuniversity Med- 
ical Center 349 

North Carolina Academy of General Practice 349 

County Societies 349 

News Notes 350 

Announcements 350 

Book Reviews 

354 

The Month in Washington 

355 

In Memoriam 

356 

Classified Advertisements 

354 

Index to Advertisers 

LI 



Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem, North Carolina, under the Act of 
August 24. 1912. Copyright 1960 by the Medical Society of the State of North Carolina. 




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(SYRUP OF CHLORAL 



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A palatable chloral hydrate syrup 
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JONES and VAUGHAN 
Richmond 26, Virginia 



Another 
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L^f 






FREE: Wesson recipes, available in quantity for your patients, show how to 

prepare meats, seafoods, vegetables, salads and desserts with po/y-unsaturated 
vegetable oil Request quantity needed from The Wesson People, 

Dept. N, 210 Baronne St., New Orleans 12, La. 



Dietary Linoleic Acid and Linoleate— Effects in Diabetic and 
Nondiabetic Subjects with and without Vascular Disease 



\A paper by Laurance W. Kinsell, M.D., et al., 
{excerpted from Diabetes — The Journal of the 
I American Diabetes Association, May-June 1959 

*' Linoleic acid as the major 'hypocholesterolemic 

\agent' in vegetable fats. The question has been 

raised as to the mechanism of lowering of the 

plasma lipids by a variety of vegetable fats. 

Among the entities present in or absent from 

vegetable fat which have been considered are: 

(a) the absence of cholesterol; (b) the presence 

of certain vegetable sterols; (c) the presence of 

certain vegetable phospholipids; (d) the nature 

(of one or more of the fatty acids present; (e) 

I the presence of trace materials. 



h the diet 



.. 



:The absence of cholesterol has been excluded as 

I a major factor. 5a Phospholipids, if they contain 
la sufficient quantity of unsaturated fatty acids 
imay produce a striking reduction. In our experi- 
ence thus far saturated phospholipids fail to pro- 
duce such an effect. 7 

Beveridge and his associates believe that veg- 
■letable sterols, particularly beta-sitosterol, are re- 

II sponsible to a significant degree for the cholesterol- 
||lowering effect. 8 In our experience the vegetable 

I sterols have a relatively weak and unpredictable 
effect of this sort. 
Since the fatty acids of animal fats are pre- 
dominantly saturated, and the fatty acids of most 
! vegetable fats are predominantly polyunsaturated, 
|with linoleic acid as the major component of the 
vegetable fats which lower cholesterol and other 
lipids, the question arises whether linoleic acid 
llper se is capable of lowering plasma lipids. As 
reported previously 7 this is indeed the case. In a 
recent study in a young male with peripheral 
atherosclerosis in association with elevation of 
plasma cholesterol and of total lipids, ethyl lino- 
i leate produced a greater fall in the plasma lipid 
| levels than had moderate amounts of natural 
sources of unsaturated fat. Linoleic acid, there- 
fore, appears to be the most important single 
lipid-lowering component of vegetable fat. 
* * * 

Significantly higher levels of cholesterol were 
observed during oleate administration than dur- 
ing administration of equal amounts of linoleate. 



The relatively low cholesterol values during the 
second oleate period may have been related to 
linoleate stored in fat depots. The fatty acid com- 
position of the cholesterol esters reflected the 
fat which was fed, i.e., the mono-enoic+ acid 
content averaged more than 40 per cent during 
oleate feeding and less than 20 per cent during 
linoleate ingestion. Essentially, a mirror image 
of this resulted during linoleate feeding, at which 
time di-enoic acid predominated. 

The data presented in this paper appear to estab- 
lish that linoleic acid administered either as puri- 
fied ethyl ester or as naturally occurring fat, in 
sufficient quantity, in properly constructed diets, 
will reduce plasma lipids to normal levels. The 
amount of linoleic acid required appears to bear 
a direct relationship to the amount of saturated 
fat included in the diet. Linoleic acid require- 
ment may also bear a significant relationship to 
the amount of atherosclerosis present. 

The transition from evaluation of the effect of 
dietary entities upon plasma lipids, to the evalua- 
tion of the effect of such materials upon vascular 
disease is difficult. However, such evaluation is 
not impossible. The requisites are adequate meas- 
uring sticks and well-controlled studies of suffi- 
cient duration. The duration of observation of 
effects of unsaturated fat in diabetic and non- 
diabetic patients with vascular disease is in no 
instance more than five years, and in the majority 
of instances, less than three. Our present impres- 
sion is that improvement has occurred in some 
patients with atherosclerosis and with diabetic 
retinal and renal disease which was more than 
we would have anticipated in terms of the natural 
course of the disease. However, since it is well 
known that major fluctuations in these diseases 
can occur in individuals receiving no treatment, 
we believe it is appropriate at this time to say 
that no untoward effects appear to result when 
one prescribes diets containing large amounts of 
unsaturated fat for patients with such diseases, 
and it is not impossible that beneficial effects may 
be associated with such diets." 
# » -* 

5a Kinsell. L.W., Partridge, J. W., Boling, L.. Margen. S.. 
and Michaels. G.D.: Dietary modification of serum cholesterol 
and phospholipid levels. J. Clin. Endocrinol and Met. 12:909, 
1952. 

7 Kinsell, L. W., Friskey, R., Splitter, S.. Michaels. G. D. : 
Essential fatty acids, lipid metabolism, and atherosclerosis. 
Lancet 1:334, 1958. 

8 Beveridge, J.M., Connell. W.F., Firstbrook, J. B.. Mayer, 
G.A., and Wolfe. M.J. : Effects of certain vegetable and animal 
fats on plasma lipids of humans. J. Nutrition 56:311, 1955. 

7 Mono-enoic (mono-unsaturated) acid is presumably synony- 
mous under these conditions with oleic acid and di-enoic (di- 
unsaturated) acid with linoleic acid 



Where a vegetable (salad) oil is medically recommended for a cholesterol 
depressant regimen, Wesson is unsurpassed by any readily available brand. 

WESSON'S IMPORTANT CONSTITUENTS 

Wesson is 100% cottonseed oil . . . winterized and of selected quality Palmitic, stearic and myristic glycerides (saturated) 25-30% 

Linoleic acid glycerides (poly-unsaturated) 50-55% Phytosterol (predominantly beta sitosterol) 0.3-0.5% 

; Oleic acid glycerides (mono-unsaturated) 16-20% Total tocopherols 0.09-0.12% 

Total unsaturated 70-75% Never hydrogenated— completely salt free 



VI 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 




Carrying on 

congestion-free 

with fast-acting 




NASAL SPRAY 

At the first allergic sneeze, two inhalations from the NTz Nasal Spray act speedily to bring excep- 
tional relief of symptoms. The first spray shrinks the turbinates and enables the patient to breathe 
through his nose again. The second spray, a few minutes later, opens sinus ostia for essential 
ventilation and drainage. Excessive rhinorrhea is reduced. nTz is well tolerated and provides safe 
"inner space" without causing chemical harm to the respiratory tissues. 
NTz is a balanced combination of three thoroughly evaluated compounds: 
;N eo-Synephrine® HCI, 0.5% to shrink nasal membranes and sinus ostia and provide 

inner space 
(T henfadil® HCI, 0.1% to provide powerful topical antiallergic action and lessen rhinorrhea 
(Z ephiran^ 1 CI, 1:5000 (antibacterial wetting agent and preservative) to promote spread and 
penetration of the formula to less accessible nasal areas 
HTzis supplied in leakproof, pocket size, squeeze bottles of 20 cc. and in bottles of 30 cc. with dropper. 



QUICK SYMPTOMATIC RELIEF OF HAY FEVER OR PERENNIAL RHINITIS 

nT;, Neo-Synephrine (brand of phenylephrine), Thenfadtl (brand of thenyldiamine) and 
Zephiran (brand of benzalkonium, as chloride, refined), trademarks reg. U. S. Pat. Off. 



UljinWiob 

LABORATORIES 
New York 18, N. Y. 






August, 1960 



ADVERTISEMENTS 



VII 




DIAGNOSIS 




New (2nd) Edition! 

Frederick and Towner- 
The Office Assistant 
in Medical Practice 

This handy manual will save you time and 
money in training an efficient office assistant. It 
is packed with help on every phase of her job 
— as receptionist, secretary, nurse, bookkeeper 
and technician. 

These are the kind of problems on which your 
assistant will find valuable help: What should you 
say in a series of collection letters? How do you 
keep a narcotics inventory? What should you 
remember in preparing the doctor's bag? To 
whom do the patient's medical records belong? 
How do you sharpen a hypodermic needle? 
How do you prepare a patient for pelvic ex- 
amination? etc. 

The authors have brought this new edition fully 
up-to-date. The chapter on Bookkeeping is ex- 
panded with many new illustrations on the 
"write-it-once" bookkeeping system, etc. The 
chapter on Instruments is now much more de- 
tailed and clearly illustrated. Much new help is 
added on sterilization. 

By Portta M. Frederick, Instructor, Medical Office Assist- 
ing, Long Beach City College; and Carol Towner, Director 
of Special Services, Communications Division, American 
Medical Association. 407 pages, 5H" x 8", illusttated. S5.25. 

New (2nd) Edition! 



2 Companion Volumes 

by Paul Williamson, M. D. 

Office Diagnosis 

New! Written from the author's long experience 
in general practice, this book offers sound, ready-to- 
use advice on solving the family physician's daily 
diagnostic problems. With the help of simple line 
illustrations, Dr. Williamson informally details those 
diagnostic techniques that can be performed right 
in your own office. 

97 important signs and symptoms are discussed. Be- 
ginning with symptomatic evidence, the author takes 
you back to its possible causes to help you arrive 
more easily at a tenable diagnosis. You will find 
symptoms such as headache, hypertension, papular 
rash, anorexia, cough, cyanosis, heart murmurs, con- 
stipation, incontinence, pain in the breasts, leu- 
korrhea clearly covered. Where pertinent, Dr. 
Williamson offers definitive help on: etiology, his- 
tory taking, general examination of the patient, 
x-ray, laboratory tests, drug therapy, diagnostic pit- 
falls to avoid, complications, etc. 

If you are familiar with Williamson' s Office Pro- 
cedures (below), you know the kind of useful, 
down-to-earth help to expect from this new volume. 

By Paul Williamson, M.D. 470 pages, 8"xll", with 350 
illustrations. $12.50. New.' 



Office Procedures 

Dr. Williamson fully discusses 379 useful manage- 
ment procedures for 171 common disorders and 
diseases in this unusual book. Aided by crystal clear 
illustrations, he tells you exactly how to best proceed 
with those techniques that can be safely and effec- 
tively performed in your own office. You will find 
precise descriptions of: how to irrigate the ear; how 
to pack for nosebleed; how to construct and fit a 
truss in inguinal hernia; how to treat muscle tears 
and ruptures; how to retrieve a retracted tendon; 
how to properly incise and drain a breast abscess; etc. 

By Paul Williamson, M.D. 412 pages, 8"xll", with 1100 
illustrations. 512.50. Published 1955. 



Order from W. B. SAUNDERS CO M PAN Y-West Washington Sq., Phila. 5 1 



Please send me the following books and charge my account : 

□ Williamson's Office Diagnosis, $12.50 Q Williamson'sOfficeProcedures,$12.50 
□ Frederick & Towner's The Office Assistant, $5.25 




Name 

Address SJG-860. 



VIII NORTH CAROLINA MEDICAL JOURNAL August, 1060 

Medical Society of the State of North Carolina 

OFFICERS — 1960 

President — Amos Neill Johnson, M.D., Garland 

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte 
Past President — John C. Reece, M.D., Grace Hospital, Morganton 
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville 
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest 
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh 
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh 
The President, Secretary and Executive Director are members ex-officio 

of all committees 
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington 
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville 



COUNCILORS — 1958 - 1961 

First District— T. P. Brinn, M.D., 118 W. Market Street, Hertford 

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro 
Sccoyid District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston 

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington 
Third District — Dewey H. Bridger, M.D., Bladenboro 

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville 
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg 

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton 
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet 

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst 
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh 

Vice Councilor— Rives W. Taylor, M.D., P.O. Box 1191, Oxford 
Seventh District — 

Vice Councilor — Edward S. Bivens, M.D., Stanly County Hospital, Albemarle 
Eighth District— -Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro 

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin 
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury 

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville 
Tenth District — William A. Sams, M.D., Main Street, Marshall 

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill 

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION 

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte 

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro 

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh 

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst 

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville 

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham 

SECTION CHAIRMEN 1959-1960 

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard 
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City 
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott 

Avenue, Charlotte 
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham 
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh 
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston 
Public Health and Education — Isa C. GRANT, M.D., Box 949, Raleigh 
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital, 

Chapel Hill 
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine, 

Winston-Salem 
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville 
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown 
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue, 

Charlotte 
Student AM A Chapters — Mr. John Feagin, Duke University School of Medicine, 

Durham 




\ 



Save a 

family breadwinner 

lost time from 

LOW BACK PAIN 

with 

TmncopaF 

Brand of chlormezanone 

effective oral skeletal 

muscle relaxant 
and mild tranquilizer 









Trancopal enables patients 
to resume their duties in 
from one to two days. 

In a recent study of Trancopal in industrial medi- 
cine, 1 results from treatment with this "tranquil- 
axant" were good to excellent in 182 of 220 
patients with muscle spasm or tension states. From 
clinical examination of those patients in whom 
muscle spasm was the main disorder, ". . . it was 
apparent that the combined effect of tran- 
quilization and muscle relaxation enabled 
them to resume their normal duties in 
from twenty-four to forty-eight hours. 
... It is our clinical impression that 
Trancopal is the most effective oral 
skeletal muscle relaxant and mild 
tranquilizer currently available." 1 
Side effects occurred in only 12 patients, and: 
"No patient required that the dosage be reduced 
to less than one Caplet three times daily because 
of intolerance." 1 



Clinical results with TvSttlCOpsJf 





Excellent 


Good 


Fair 


Poor 


Total 


,0W BACK SYNDROMES 












Acute low back strain 


25 


19 


8 


6 


58 


Chronic low back strain 


11 


5 


1 


1 


18 


"Porters' syndrome"* 


21 


5 


1 


1 


28 


Pelvic fractures 


2 


1 


— 


— 


3 


IECK SYNDROMES 












Whiplash injuries 


12 


6 


2 


1 


21 


Torticollis, chronic 


6 


2 


3 


2 


13 


ITHER MUSCLE SPASM 












Spasm related to trauma 


15 


6 


1 


— 


22 


Rheumatoid arthritis 


— 


18 


2 


1 


21 


Bursitis 


2 


6 


1 


— 


9 


ENSION STATES 


18 


2 


4 


3 


27 


OTALS 


112 
(51%) 


70 
(32%) 


23 

(10%) 


15 
(7%) 


220 

(100%) 



♦Over-reaching in lifting heavy bags resulting in sprain of upper, middle, and lower back muscles. 



Dosage: Adults, 200 or 100 rag. orally three or four times daily. 

Relief of symptoms occurs in from fifteen to thirty minutes and lasts from four to six hours. 



How Supplied: Trancopal Caplets® 

200 mg. (green colored, scored), bottles of 100. 
100 mg. (peach colored, scored), bottles of 100. 

1. Kearney, R. D.: Current Therap. Res. 2:127, April, 1960. 



?06M Trancopa! (brand of chlormezanone) and Caplets, trademarks reg. U. S. Pat. Off. 




LABORATORIES, New York 1 8, N. Y. 




she calls it "nervous indigestion" 



diagnosis: a wrought-up patient with a functional 
gastro-intestinal disorder compounded by inade- 
quate digestion, treatment: reassurance first, then 
medication to relieve the gastric symptoms, calm 
the emotions, and enhance the digestive process. 
prescription: new Donnazyme— providing the mul- 
tiple actions of widely accepted Donnatals" and 
Entozyme^— two tablets t.i.d., or as necessary. 



Each Donnazyme tablet contains 
—In the gastric-soluble outer layer: Hyoscyamine 
sulfate, 0.0518 mg.; Atropine sulfate, 0.0097 mg.; 
Hyoscine hydrobromide, 0.0033 mg.; Phenobarbi- 
tal (Vs gr.), 8.1 mg.; and Pepsin, N. F., 150 mg. 
In the enteric-coated core: Pancreatin, N. F., 300 
mg., and Bile salts, 150 mg. 

ANTISPASMODIC - SEDATIVE - DIGESTANT 



DONNAZYME 

A. H. ROBINS COMPANY, INCORPORATED . RICHMOND 20, VIRGINIA 



August, 1960 



ADVERTISEMENTS 



XI 



ALL OVER AMERICA! 

KENT with the MICRONITE FILTER 

IS SMOKED BY 
MORE SCIENTISTS and EDUCATORS 

than an y other ci g arette !* 



FIVE TOP BRANDS OF CIGARETTES 
SMOKED BY AMERICAN SCIENTISTS 



KENT. 

BRAND "A" I 
BRAND "G" ■ 
BRAND "F" 

BRAND "B 4 



15.3% 
10.5% 
7.9% 
7.6% 

7.3% 




\ \1 



This does not constitute a 
professional endorsement 
of Kent. But these men, like 
millions of other Kent smokers, 
smoke for pleasure, and choose 
their cigarette accordingly. 






The rich pleasure of smoking 
Kent comes from the flavor 
of the world's finest natural 
tobaccos, and the free and 
easy draw of Kent's famous 
Micronite Filter. 



If you would like the booklet, "The Story of Kent", for your 
own use, write to: P. Lorillard Company — Research De- 
partment, 200 East 42nd Street, New York 17, New York. 




For good smoking taste, WM [Mil? 

it makes good sense to smoke IrXiHINllll 



^e Results ol a continuing sludy of cigarette preferences, conducted oy O'Brien Sherwood Associates, N.Y.. N.Y. 
A PRODUCT OF P LORIUARD COMPANY FIRST WfTW THE FINEST CIGARETTES THROUGH LORILLARD RESEARCH 



C I940.F lOniAOCCt 



XII 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



in respiratory allergies 

TRISTACOMP 



Orally-administered triple antihistamines plus two effec- 
tive decongestant agents— to prevent histamine-induced 
dilatation and exudation of the nasal and paranasal 
capillaries and to help contract already engorged capil- 
laries, providing welcome relief from rhinorrhea, stuffy 
noses, sneezing and sinusitis. 






convenient 
dosage forms 



TRISTACOMP TABLETS 

Each sustained release tablet: 

Chlorpheniramine Maieafe 2.5 mg. 

Phenyjtoloxamine Citrate 12.5 mg, 

Pyrifamine Maleate 25.0 mg. 

Phenylephrine Hydrochloride 10.0 mg. 

Phenylpropanolamine Hydrochloride 30.0 mg. 

Dosage: One tablet morning and night 

TRISTACOMP LIQUID 

£ach 5 cc feaspaonfu/ provides one-fourth the above 

formula. 

Dosage: Adults, two teaspoonfuls three to four times 

daily. Children, one-ha/f to fwo reaspoonfy/s, 

according fo age. 





c c 



jsual medications 
act only here 




olief in MAY FKV^ 



iSn 



NEW 



• • 



iflSt. - 





$»«>, 




acts here 



to relieve both nasal 



and chest discomfort 



M 







AV 





provides both 



/upper 
an 



respiratory decongestion 
and bronchial decongestion 







Many hay fever patients also experience chest discomfort. For these patients, 

new ISOCLOR provides relief along the entire respiratory tract. 

COMBINES the nasal and bronchial decongestant action of d-isoephedrine with 

the histamine blocking action of chlorpheniramine. 

RELIEVES the discomforts of rhinorrhea, itching, sneezing, hyperlacrimation 

and post nasal drip— let s the patient get a full night's rest— with minimal daytime 

drowsiness, CNS or pressor stimulation. 



TABLETS AND SYRUP for adults and children . . . 
COMPOSITION: Per tablet Per 5 ml. syrup 

Chlorpheniramine maleate 4 mg. 2 mg. 

d-lsoephedrine HCI 25 mg. 12.5 mg. 

DOSE: Tablets: One tablet 3 or 4 times daily. Syrup: Children: 3-6 yrs. 
Vz tsp. t.i.d.; 6-12 yrs. 1 tsp. t.i.d.; Adults: 2 tsp. t.i.d. 

AVAILABLE: Tablets: Bottles of 100. Syrup: Pint bottles. 



ARNAR-STONE 

Laboratories, Inc. 
Mt. Prospect, Illinois 



XIV 



NORTH CAROLINA MEDICAL JOURNAL 



August, 19C.0 




Naturetin 

Squibb Benzydroflumethiazide 

NaturetincK 

Squibb Benzydroflumethiazide with Potassium Chloride 

"...a safe and extraordinarily 
effective diuretic..." 1 



Naturetin — reliable therapy in edema and 
hypertension — maintains a favorable uri- 
nary sodium-potassium excretion ratio . . . 
retains a balanced electrolytic pattern: 

"... the increase in urinary output occurs 

promptly . . . " l 
"... the least likely to invoke a negative 

potassium balance . . ."' 
"... a dose of 5 nig. of Naturetin produces a 

maximal sodium loss." 2 
"... an effective diuretic agent as manifested 

by the loss in weight . . . " 3 
"... no apparent influence of clinical 

importance on the serum electrolytes 

or white blood count." 3 
"... no untoward reactions were attributed 

to the drug." 4 
Although Naturetin causes the least serum 
potassium depletion as compared with other 
diuretics, supplementary potassium chloride in 
Naturetin c K provides added protection when 
treating hypokalemia-prone patients; in con- 
ditions where likelihood of electrolyte imbal- 
ance is increased or during extended periods 
of therapy. 



Numerous clinical studies confirm the effec- 
tiveness 1 ' 1 '' of Naturetin as a diuretic and 
antihypertensive — usually in dosages of 5 
mg. per day. 

■ the most potent diuretic, mg. for mg.— more 
than 100 times as potent as chlorothiazide 

■ prolonged action — in excess of 18 hours ■ 
maintains its efficacy as a diuretic and anti- 
hypertensive even after prolonged or increased 
dosage use ■ convenient once-a-day dosage — 
more economical for patients ■ low toxicity — 
few side effects— low sodium diets not necessary 

■ not eontraindicated except in complete renal 
shutdown ■ in h ypertension— significant lower- 
ing of the blood pressure. Naturetin may be 
used alone or with other antihypertensive drugs 
in lowered doses. 

Supplied: Naturetin Tablets, 5 mg. (scored) 
and 2.5 mg. Naturetin cK (5 c 500) Tablets 
(capsule-shaped) containing 5 mg. benzydro- 
flumethiazide and 500 mg. potassium chloride. 
Naturetin c K (2.5 c 500) Tablets (capsule- 
shaped) containing 2.5 mg. benzydroflumethia- 
zide and 500 mg. potassium 
chloride. SQUIBB 



References: 1. David, N. A.: Porter, G. A., and Gray, R. H.: Monographs on Therapy S:60 (Feb.) I960. 
2. Stenberg-, E. S., Jr.; Benedetti, A., and Forsham, P. H.: Op. clt. 5:46 (Feb.) 1960. 3. Fuchs, M.; Moyer, 
J. H., and Newman, B.E.: Op. clt. 5:55 (Feb.) 1960. 4. Marriott. H. J. L., and Schamroth, L.: Op. cit. 5:14 
(Feb.) 1960. 5. Ira, G. H., Jr.; Shaw, D. M., and Bogdonoff, M. D.: North Carolina M. J. 21:19 (Jan.) 1960. 
6. Cohen, B. M.: M. Times, to be published. 7. Breneman, G. M., and Keyes, J. W.: Henry Ford Hosp. M. Bull. 
7:281 (Dec.) 1959. 8. Forsham, P. H.: Squibb Clin. Res. Notes 2:5 (Dec.) 1959. 9. Larson, E.: Op. cit. 2:10 
(Dec.) 1959. 10. Klrkendall, W. M.: Op. clt. 2:11 (Dec.) 1959. 11. Yu, P. N.: Op. cit. 2:12 (Dec.) 1959. 
12. Weiss, S.; Weiss, J., and Weiss, B.: Op. clt. 2:13 (Dec.) 1959. 13. Moser, M.: Op. cit. 2:13 (Dec.) 1959. 
14. Kahn, A., and Greenblatt, I. J.: Op. cit. 2:15 (Dec.) 1959. 15. Grollman, A.: Monographs on Therapy 
9:1 (Feb.) 1960. 'naturetin' is a squibs trademark. 



^..SQi "&■ W 



Squibb Quality— the 
Priceless Ingredient 



PAPAIN 

IS THE 

KEY 

to complete, thorough 
vaginal cleansing 




mucolytic, acidifying, 
ihysiologic vaginal douche 



The papain content of Meta Cine is the key 
•eason why it effects such complete cleansing of 
he vaginal vault. Papain is a natural digestant, 
md is capable of rendering soluble from 200- 
!00 times its weight of coagulated egg albumin. 
n the vagina, papain serves to dissolve mucus 
jlugs and coagulum. 

Vteta Cine also contains lactose — to promote 
growth of desirable Doderlein bacilli — and 
nethyl salicylate, eucalyptol, menthol and 
;hlorothymol, to stimulate both circulation and 
normal protective vaginal secretions. Meta 
fine's pleasant, deodorizing, non-medicinal fra- 
grance will meet your patients' esthetic demands. 

Supplied in 4 oz. and 8 oz. containers, and in 
Doxes of 30 individual-dose packets. Dosage: 
I teaspoonfuls, or contents of 1 packet, in 2 
quarts of warm water. 




EH 

:i:»\yten 



BRAYTEN PHARMACEUTICAL COMPANY Chattanooga 9, Tennessee 



XVI NORTH CAROLINA MEDICAL JOURNAL August, 1960 



Proven 

in over five years of clinical use and 
more than 750 published clinical studies 

Effective 

for relief of anxiety and tension 

Outstandingly Safe 

• simple dosage schedule produces rapid, reliable 
tranquilization without unpredictable excitation 

• no cumulative effects, thus no need for difficult 
dosage readjustments 

• does not produce ataxia, change in appetite or libido 

• does not produce depression, Parkinson-like symptoms, 
jaundice or agranulocytosis 

• does not impair mental efficiency or normal behavior 






for 

the 
tense 
and 
nervous 
patient 




Despite the introduction in recent years of "new and dif- 
ferent" tranquilizers, Miltown continues, quietly and 
steadfastly, to gain in acceptance. Generically and under 
the various brand names by which it is distributed, 
meprobamate (Miltown) is prescribed by the medical 
profession more than any other tranquilizer in the world. 

The reasons are not hard to find. Miltown is a known drug, 
evaluated in more than 750 published clinical reports. Its 
few side effects have been fully reported; there are no 
surprises in store for either the patient or the physician. 
It can be relied upon to calm anxiety and tension quickly 
and predictably. 



Usual dosage: One or two 
400 mg. tablets t.i.d. 
Supplied : 400 mg. scored tablets, 
200 mg. sugar-coated tablets; 
or as meprotabs*— 400 mg. 
unmarked, coated tablets. 



Miltown 



meprobamate (Wallace} 



" WALLACE LABORATORIES / New Brunswick, N. J. 



"Gratifying" relief from 



for your patients with 
'low back syndrome' and 
other musculoskeletal disorders 

POTENT muscle relaxation 
EFFECTIVE pain relief 
SAFE for prolonged use 



stiffness and pain 

^IdXllyllli^ relief from stiffness and pain 

in 106-patient controlled study 

(as reported inJ.A.M.A., April 30, 1960) 

"Particularly gratifying was the drug's [Soma's] 
ability to relax muscular spasm, relieve pain, and 
restore normal movement ... Its prompt action, 
ability to provide objective and subjective assist- 
ance, and freedom from undesirable effects rec- 
ommend it for use as a muscle relaxant and anal- 
gesic drug of great benefit in the conservative 
management of the 'low back syndrome'." 

Kestler, O.: Conservative Management of "Low Back Syndrome" , 

J.A.M.A. 172: 2039 (April 30) I960. 

FASTER IMPROVEMENT- 79% complete or marked 

improvement in 7 days (Kestler) 

EASY TO USE— Usual adult dose is one 350 mg. tablet 
three times daily and at bedtime. 

SUPPLIED: 350 mg., white tablets, bottles of 50. 

For pediatric use, 250 mg., orange capsules, bottles of 50. 



Literature and samples on request. 




(CARISOPRODOL, WALLACE) 

WALLACE LABORATORIES, CRANBURY, NEW JERSEY 



9 * V 8 

? n 



s** s s * s 



?« * ? s? ? 



S 8 f t * 
$: 
8 
8 
888 8 8888 8 
8 
8 
8 



GONORRHEA IS ON THE MARCH AGAIN... 



a new timetable for recovery: 

only six capsules of TETREX can cure a male patient with gonorrhea in just one day* 




U.S. PAT. NO. 2, 79 1,609 

THE ORIGINAL TETRACYCLINE PHOSPHATE COMPLEX 



TETREX CAPSULES. 250 mg. Each capsule contains: 
TETREX (tetracycline phosphate complex equivalent to 
tetracycline HCI activity) - 250 mg. 
DOSAGE: Gonorrhea in the male -Six capsules ol 
TETREX in 3 divided doses, in one day. 

* Marmell, M-, and Prigot, A.: Tetracycline phosphate complex in the treat- 
ment of acute qonococcal urethritis In men. Antibiotic Med. & Clin. Ther. 
6:108 (Feb.) 1959. 



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I I 



XX 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



Squibb Announces 




new chemically improved penicillin 
which provides the highest blood 
levels that are obtainable with oral 
penicillin & — ^^ — m therapy 



As a pioneer and leader in penicillin therapy 
for more than a decade, Squihb is pleased 
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proved oral penicillin, available for clinical use 

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tain higher blood levels — with greater speed — than \ 
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have a 2:1 superiority in producing peak blood levels 
over potassium penicillin V.* 

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(Chemipen is stable at 37 C C. at pH 2 to pH 3). which 
in turn makes possible the convenience of oral treatment. 




And the economy for your patients will be of 
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than comparable penicillin V preparations. 

Dosage: Doses of 125 mg. (200,000 u.) or 

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severity of the infection. The usual precautions 

0t/ must be carefully observed with Chemipen, as with 

all penicillins. Detailed information is available on 

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Supply: Chemipen Tablets of 125 mg. (200.000 u.) and 

250 mg. (400.000 u.l, bottles of 24 tablets. Chemipen 

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". . . Atarax appeared to reduce anxiety 
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M. : Pediat. Clin. North America 5:573 
(Aug.) 1958. 



". . . seems to be the agent of choice 
in patients suffering from removal dis- 
orientation, confusion, conversion hys- 
teria and other psychoneurotic condi- 
tions occurring in old age." Smigel, 
J. 0., et al.i J. Am. Geriatrics Soc. 
7:61 (Jan.) 1959. 



"All [asthmatic] patients reported 
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". . . especially well-suited for ambula- 
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Nathan, L. A., and Andelman, M. 
B : Illinois M. J. 112:171 (Oct.) 
1957. 



Seftel, E.: Am. Pract. & Digest 
Treat. 8:1584 (Oct.) 1957. Negri, 
F.: Minerva med. 48:607 (Feb. 
21) 1957. Shalowitz, M. : Geri- 
atrics 11:312 (July) 1956. 



Eisenberg, B. C: J.A.M.A. 169:14 
(Jan. 3) 1959. Coirault, R., et al.: 
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1956. Robinson, H. M.. Jr., et al.: 
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nal. Rec. Med. 169:379 (June) 
1956. 

SUPPLIED: Tablets, 10 mg., 25 
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XXIV 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



Co-PyroniF 

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ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.«. 



North Carolina Medical Journaj 

Owned and Published by 
The Medical Society of the State of North Carolina 



Volume 21 



August, 1960 



No. 8 



Symposium on Acute Surgical Conditions 

Of the Abdomen 

Acute Abdominal Pain Associated 
With Vascular Emergencies 

Gordon M. Carver, Jr., M.D. 
Durham 



Acute abdominal pain of vascular origin 
is still rare in comparison with that of ap- 
pendicitis, peptic ulcer, and cholecystitis : 
however, as our population age increases, ab- 
dominal vascular emergencies will become 
more frequent. Most of these vascular le- 
sions are of arterial origin- and the earlier 
the diagnosis is made and definitive treat- 
ment instituted, the better the ultimate re- 
sult. 

Dissecting and Ruptured Abdominal 
Aortic Aneurysms 

The abdominal aneurysm may be relative- 
ly asymptomatic until it begins to enlarge 
as a result of dissection. Varying degrees 
of severe pain in the abdomen or back then 
develops and is thought to be due to disten- 
tion and tearing of the muscular layers of 
the aorta. 

The diagnosis of dissecting abdominal 
aortic aneurysm is usually quite simple. 
Palpation of the abdomen reveals a pulsat- 
ing mass which is often noted by the patient 
himself. A lateral roentgenogram of the 
lumbar spine may reveal calcification of the 
aortic wall and determine the diameter of 
the aneurysm. Angiography can be used to 
establish the diagnosis but is usually not 
necessary. 

The clinical diagnosis of ruptured abdom- 
inal aortic aneurysm is made on the basis of 
. an acute onset of abdominal pain, with or 
without shock, and the presence of a pulsat- 
ing mass increasing rapidly in size. A flat 

Presented before the Section on Surgery, Medical Society 
Of the State of North Carolina. Raleigh, May 10, 1960. 



plate of the abdomen may reveal an obliter- 
ated psoas shadow as well as calcification in 
the aneurysmal wall. Occasionally the blood 
hematacrit and blood pressure may be main- 
tained at a normal level for several hours or 
even days after rupture of the aneurysm. 
The point of rupture is most commonly seen 
posteriorly, but it may be on the anterior 
or lateral surface of the aorta. 

The treatment mortality rate in elective 
resections has diminished to such a point 
that it is sound to recommend removal of 
almost all abdominal aortic aneurysms on 
diagnosis. One of the most compelling rea- 
sons for resection is that more than 50 per 
cent of patients with ruptured aneurysms, 
although aware of the presence of the lesion, 
have had no symptoms prior to the rupture. 
In general the larger the aneurysm the 
greater the probability of rupture. Justifi- 
cation for the emphasis on elective surgery 
in these cases is the evidence that it increases 
life expectancy. DeBakey and Cooley (1) have 
shown a postoperative survival rate of 82 
per cent. Wright and others'- 1 , in their an- 
alysis of the natural course of the disease, 
found a steady decline in survival rates from 
60 per cent at the end of one year to 16 
per cent at the end of three years. There 
is of course little or no argument regarding 
the immediate indications for resection of 
dissecting or ruptured aortic abdominal 
aneurysms. 

The surgical treatment consists of excis- 
ing the aneurysm through a long xiphoid to 
pubic incision, replacing the excised segment 



314 



NORTH CAROLINA MEDICAL JOURNAL 



August, liiiiO 



of aorta with a synthetic graft made of 
teflon or dacron. Since most abdominal an- 
eurysms arise distal to the renal arteries, 
the aorta can be cross-clamped below these 
vessels. Before the aorta is cross-clamped, 
the distal site of anastomosis is determined 
and these vessels are made ready for im- 
mediate anastomosis. In most cases the in- 
ferior mesenteric and lumbar arteries can be 
ligated and cut prior to the actual cross- 
clamping of either the iliac vessels or the 
abdominal aorta itself. During resection 
heparin is pumped into both lower extremi- 
ties through a small polyethylene tube in- 
serted into the distal arterial system by the 
use of special pumping apparatus or with 
syringe and three-way stop-cock. The an- 
eurysm is then removed and the plastic graft 
sutured in place as rapidly as possible. 

The resection of a ruptured aneurysm dif- 
fers in that the patient is often moribund 
or in semi-shock. With adequate blood for 
replacement, temporary proximal control of 
the aorta is obtained by exerting pressure on 
the upper abdominal aorta against the spine 
in the lesser peritoneal sac and then placing 
an occluding clamp on the aorta below the 
renal arteries. The iliac vessels are cross- 
clamped and the ruptured aneurysm is rap- 
idly removed. The smaller bleeding vessels 
are controlled and the graft is sewn in place. 
In all cases bilateral lumbar sympathectomy 
is performed prior to abdominal closure. 

The mortality associated with resection 
of aortic aneurysms is about 5 to 10 per 
cent in the uncomplicated cases. In rup- 
tured aneurysms it is still 25 to 50 per cent, 
depending on the patient's general condi- 
tion at the time of surgery. 

Dissecting Thoracic Aortic Aneurysms 

The predominant presenting symptom of 
a dissecting thoracic aortic aneurysm may 
be acute epigastric abdominal pain. Usual- 
ly the pain is substernal in origin and may 
simulate myocardial infarction ; however, 
neurologic, renal and abdominal manifesta- 
tions are frequent. These symptoms consist 
of numbness, paraplegia, coma, hematuria, 
and abdominal pain radiating to the legs or 
back' and are usually related to the point of 
dissection, with involvement of the corre- 
sponding organ systems. The presence of 
neurologic symptoms or signs in patients 
with thoracic or abdominal pain may be a 
clue to the early correct diagnosis of a dis- 
secting thoracic aortic aneurysm. 



The physical manifestations of a dissect- 
ing aneurysm are not diagnostic. A precor- 
dial apical or basal systolic murmur is pres- 
ent in about 40 per cent of the cases. A di- 
astolic murmur over the aortic area is con- 
sidered to be of the greatest diagnostic sig- 
nificance, but is present in only a small per- 
centage of cases. This is simply a reflection 
of the small number of individuals with in- 
volvement of the ascending aorta or aortic 
annulus. Brachial blood pressure differen- 
tial, tracheal deviation, cervical venous dis- 
tention, abdominal aneurysm, or obliteration 
of peripheral pulses is rarely observed. Elec- i 
trocardiograms reveal myocardial ischemia, 
left ventricular strain, or disturbances of 
rhythm in about 75 per cent of the patients. . 

Roentgenograms of the chest usually re- 
veal widening of the supracardiac mediasti- 
num and radiolucence of the arch and de- 
scending aorta in the region of the false 
passage. Angiocardiograms taken with the 
patient in an oblique position usually ac- 
centuate the "double-barreled" appearance 
of the lesion. This examination has been of 
utmost value in determining the nature and 
extent of the dissecting progess. 

For the cardiovascular surgeon, it is im- 
portant to divide these lesions into five cate- 
gories, which then provide a guide to the 
surgical approach and prognosis' 3 '. 

Type I : The dissecting process extends from 
the aortic annulus to a point well below 
the diaphragm. 

Treatment: Unless there is an area 

where rupture is imminent, resection 

with graft replacement is not indicated. 

Creation of a re-entry passage is usually 

the procedure of choice and may be done 

with or without the aid of hypothermia 

or atriofemoral by-pass perfusion. 

Type II : The process is localized to the 

ascending aorta and proximal transverse 

arch. 

Treatment: Excision of the lesion and 
aortic graft replacement using extra- 
corporeal pump oxygenator. 
Type III : Distal transverse arch and de- 
scending aorta. 
Type IV: The dissecting process arises atj 
the left subclavian artery and continues 
well below the diaphragm. 

Treatment: Excision of diseased tho- 
racic segment and intraluminal closure 
of distal segment prior to replacement 
grafting. 



August, 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



315 



Type V : Lesion occurs in left subclavian ar- 
tery with dissecting process remaining 
localized in the descending aorta. 

Treatment: Excision of the entire dis- 
eased segment and replacement with a 
graft. 
The latter two types comprise about 90 
per cent of the cases, and in each instance 
hypothermia or some form of by-pass-shunt 
is necessary to guard against spinal cord 
ischemia. 

In DeBakey's series of 60 cases the oper- 
ative mortality of lesions occurring below 
the subclavian was 18 per cent as compared 
to an over-all mortality of 29 per cent 131 . 
The most common type of lesion requires re- 
section of the descending aorta, so as to in- 
clude the site of origin of the dissection, 
with graft replacement and obliteration of 
the false lumen distally. 

Aneurysms of Intestinal Vessels 
Aneurysms of the major aortic branches 
to the abdominal viscera are usually palpable 
on physical examination, produce symptoms 
of abdominal pain, and have the great ten- 
dency to rupture common to all aneurysms. 
Splenic aneurysms occur in the main trunk 
of the vessel and are twice as common in 
women, particularly pregnant women. Sple- 
nomegaly is found in about 50 per cent of 
the patients, and before rupture, symptoms 
are mild, usually consisting only of epigas- 
tric discomfort. Rupture into the lesser 
peritoneal sac is followed by severe pain in 
the back and left shoulder, associated with 
shock or signs of peritoneal irritation. The 
treatment of choice is resection of the artery 
with the aneurysm, and splenectomy. 

In aneurysms involving essential vessels 
such as the hepatic and superior mesenteric 
artery, resection with end-to-end anastomo- 
sis of the vessel is performed when possible. 
Small plastic grafts to the aorta can be used 
effectively when primary anastomosis can- 
not be performed. 

Embolism and Thrombosis of the Superior 
Mesenteric Artery 

The superior mesenteric artery is the ves- 
sel most often involved in infarction of the 
abdominal viscera in both sudden embolic 
occlusions and arteriosclerotic thrombosis. 
This is probably related to the relative size 
of the vessel, its anterior location, and the 
angle it makes with the aorta at its exit. 

Superior mesenteric arterial embolism is 
usually associated with atrial fibrillation, a 
recent myocardial infarction, or some other 



disease which provides a source of emboli. 
Sudden severe cramping periumbilical or 
epigastric pain, frequently accompanied by 
severe pain in the upper lumbar and lower 
thoracic region, follows complete embolic oc- 
clusion. The patient appears to be in early 
shock and acutely ill, but the blood pressure 
may be normal or elevated. The bowel re- 
sponds to acute ischemia with spastic con- 
tractions and loose mucoid stools. Within 
two hours the acute pain may subside, leav- 
ing the patient relatively asymptomatic. 
Unless the condition is recognized, the error 
may lead to a fatal postponement of opera- 
tive treatment. The white blood cell count 
rises early, and the peritoneal irritation and 
abdominal tenderness make their appearance 
as necrosis of the intestine, and secondary 
bacterial invasion progresses. Signs of gen- 
eralized peritonitis with abdominal disten- 
tion, shock, and leukocytosis develop, to com- 
plete the classic picture of massive intes- 
tinal infarction. Paracentesis may yield a 
characteristic dark, "prune-juice" tvpe of 
fluid. 

Early recognition of the entity and prompt 
surgical removal of the embolus before ir- 
reversible injury to the bowel has taken 
place is the treatment of choice. Reports of 
successful superior mesenteric embolectomy 
have appeared with increasing frequency 
since the urgency and value of the operation 
was stressed by Klass ,!1 . 

A typical history in a patient liable to 
emboli, who begins to have acute abdominal 
pain and tenderness, leukocytosis, and guiac- 
positive stool- with absence of small-bowel 
gas on x-ray, should immediately define the 
need for emergency surgery. The reversibil- 
ity of apparently severe degrees of ischemic 
injury to the intestine after sudden occlusion 
of the circulation has been striking. Dark 
discoloration of the bowel does not neces- 
sarily mean necrosis. Even if necrosis of 
segments of the small bowel has advanced 
to a point of no return, the combination of 
embolectomy and bowel resection may allow 
the preservation of a greater length of small 
intestine. 

Technique 
When the abdomen is explored early, there 
may appear to be very minor changes in the 
circulation to the small bowel. A good pulse 
in the main superior mesenteric artery must 
be demonstrated. The ligament of Treitz is 
identified and the mesocolon and lower bor- 
der of the pancreas are reflected upward, 



316 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



exposing the superior mesenteric artery. A 
heavy ligature is passed around the main 
trunk of the artery to elevate it, and the first 
jejunal and middle colic branches are ex- 
posed. A longitudinal arteriotomy incision 
is made and the clot is removed proximally 
as far as its aortic origin. A bulldog arterial 
clamp is applied after the vessel has been 
cleared by a flush of aortic blood. The distal 
thrombus is then removed by milking the 
mesenteric vessels toward the arteriotomy 
incision. Heparin is injected into the vessel 
proximately and distally, and the incision 
is closed with No. 6-0 black silk. Anticoag- 
ulants are used in the postoperative period, 
along with antibiotics and the usual surgical 
measures that are employed after an explor- 
atory laparotomy. 

Arteriosclerotic Thrombosis of the Superior 
Mesenteric Artery tuid Vein 

Small-bowel infarction resulting from ar- 
teriosclerotic thrombosis of the superior 
mesenteric artery usually occurs by gradual 
occlusion of this vessel, and will be preceded 
by days or months of chronic gastrointes- 
tinal symptoms. The most prominent symp- 
tom is a cramping epigastric pain appearing 
an hour or two after meals; weight loss is 
due to failure to eat because of this pain. 
Malabsorption may result in the fatty frothy 
stools which characterize this disorder. In- 
farction will be accompanied by a severe at- 
tack of abdominal pain, but is apt to be less 
dramatic in onset than are the symptoms 
present with sudden embolic occlusion. 

Treatment would ideally consist of recog- 
nition in the prodromal phase, aortographic 
demonstration of narrowing of the vessel, 
and correction by thromboendarterectomy 
or replacement grafting. The atheromatous 
occlusion is almost always located in the 
first centimeter and the adjacent aortic 
wall' 51 . The vessel is cleared in a retrograde 
fashion with a small curved clamp intro- 
duced into the aortic lumen through the su- 
perior mesenteric arteriotomy. Hemorrhage 
from the vessel is readily controlled by digi- 
tal pressure between extraction efforts. The 
arteriotomy is closed, with attention given 
to distal atheromas, tacking down or in- 
cluding in the suture line the distal intima 
to avoid subsequent dissection. 

Thrombosis of the mesenteric vein is a 
rare condition usually associated with intra- 
abdominal infection. The diagnosis is diffi- 
cult to make but is suggested by an episode 
of subacute abdominal pain associated with 



the passage of blood and mucus per rectum. 
Specific surgical treatment depends on the 
underlying cause and the location of the 
vascular block. 

Aortic Saddle Embolus 

The classic evidence of a saddle embolus 
of the aorta is sudden vascular insufficiency 
of the lower extremities denoted by pain, 
pallor, sensory and motor losses, and absent 
pulses. There may also be pain in the abdo- 
men, lower back, buttocks or perineal region, 
or paresthesia depending upon the adequacy 
of the collateral circulation. The embolus 
usually arises from a thrombus in a rheu- 
matic heart with mitral stenosis or insuffi- 
ciency and atrial fibrillation, or from a mural 
thromus secondary to myocardial infarction. 

The prognosis for both life and limb is 
poor without embolectomy. Reich" 11 reported 
that only 1 of 7 patients not operated on 
survived. Burt and others' 7 ' had a similar 
experience with 16 patients, 8 of whom were 
treated conservatively ; only two lived with- 
out loss of legs. Four of 8 were operated on 
successfully without loss of limbs. In general 
the longer the delay prior to operative re- 
moval of the embolus, the poorer the prog- 
nosis, although emboli have been removed 
after a delay of 24 hours'"'. 

The operative approach may be transab- 
dominal, retroperitoneal from the left side, 
or by retrograde catheter suction of the 
femoral artery. The transabdominal ap- 
proach, employing a mid-line or paramedian 
incision, is the most popular. After proximal 
control of the aorta above the bifurcation 
and the iliac vessels below the embolus, a 
longitudinal incision is made in the aorta 
overlying the clot. The embolus is removed 
and blood is allowed to flush from both iliacs 
to clear these vessels and check their retro- 
grade flow, and then to clear the distal aorta. 
The aortic incision is then closed with con- 
tinuous No. 5-0 silk sutures. In draping the 
patient prior to operation, it is important 
to have both legs and feet in the operative 
field so that peripheral pulses can be de- 
termined immediately following removal of 
the embolus by the operating surgeon. The 
femoral or popliteal arteries can be explored, 
if necessary, to clear them of small emboli 
that may have broken off from the saddle 
embolus. 

The retroperitoneal approach from the 
left sic 1 ^ can be used in the presence of peri- 
tonitis or extensive intraperitoneal adhe- 



August, 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



3n 



sions, but it has the disadvantage of poor 
exposure of the right iliac artery and of the 
operative site in general. 

The retrograde femoral artery approach' 1 ' 
possesses the disadvantage of a blind, in- 
direct method, yet may be performed suc- 
cessfully with local anesthesia, thereby 
avoiding a laparotomy in a seriously ill pa- 
tient. In a recent study Willman and Han- 
Ion 110 ' recommend this technique not only for 
those patients who are critically ill, but in 
all patients. If the clot is not extracted suc- 
cessfully, the patient can be put to sleep 
and a transabdominal approach used. These 
authors point out that unsuccessful attempts 
at retrograde femoral removal by other op- 
erators have been due in many instances to 
the use of small catheters. 

The largest thin-walled plastic catheter 
that the vessel will accept is passed until the 
catheter impinges on the embolus. A glass 
T tube allows blood from collateral vessels 
to flow through the vent until the catheter 
tip reaches the embolus- then the suction line 
is opened and the vent is closed. Aspirated 
blood and thrombus are seen through the 
glass T tube. The catheter is slowly with- 
drawn, together with the firm embolus held 
against the tip of the catheter by suction. 
The same technique is used on the other 
side and is repeated until there is a vig- 
orous pulsital blood flow. This method was 
used successfully on 4 patients, but cannot 
be used on patients with previous obstruc- 
tions or thrombosis in the iliac vessels. 

In the postoperative management imme- 
diate heparinization is not used routinely 
after the abdominal approach if adequate 
luminal clearance has been accomplished. 
The complications associated with immedi- 
ate heparinization in terms of wound bleed- 
ing, hematoma, delayed wound healing, and 
secondary infection appear to outweigh its 
possible advantages. After the retrograde 
femoral artery approach, however, immedi- 
ate heparinization is utilized. 

If the embolus arises from the left atrium 
owing to mitral stenosis, mitral commissu- 
rotomy and atrial appendectomy is prefer- 
able to long-term anticoagulant therapy if 
the patient can tolerate the procedure. One 
advantage of the retrograde femoral ap- 
proach is that after its completion under 
local anesthesia it can sometimes be com- 
bined immediately with mitral commissu- 
rotomy. Belcher and Somerville' 11 ' found a 
less than 1 per cent incidence of postvalvu- 



lotomy embolism in 430 collected cases, and 
felt that commissurotomy was much prefer- 
able to long-term anticoagulant therapy. 

Summary 

Acute abdominal pain of vascular origin is 
most commonly due to the development of an 
aneurysm, thrombosis, or embolus in the 
arterial system within the abdomen. In gen- 
eral the earlier the diagnosis, the better the 
result of surgical treatment. 

The diagnosis of dissecting or ruptured 
abdominal aneurysms is not difficult, as the 
pulsating mass can usually be felt. Resec- 
tion of the aneurysm with graft replace- 
ment is a lifesaving procedure when success- 
ful. 

Dissecting thoracic aortic aneurysms may 
masquerade as an acute abdominal condition, 
diagnosis can usually be made by x-ray 
studies, and surgical treatment consists of 
resection with graft replacement or construc- 
tion of a re-entry passage. 

Embolism or thrombosis of the superior 
mesenteric artery may be treated by em- 
bolectomy or thromboendarterectomy if rec- 
ognized early, thus avoiding infarction of 
the small bowel. 

Diagnosis of aortic saddle embolus in its 
early stages and the use of modern vascular 
surgical techniques have improved the sal- 
vage rate considerably in the past 10 years. 

References 

1. DeBakey. M. E., Cooley. D. A., and Creech. O.. Jr.: 
Aneurysm of Aorta Treated by Resection: Analysis of 
313 cases. J. A. M. A. 163:1439-1443 (April 20) 1957. 

2. Wright. I. S., Urdaneta, E., and Wright, B. : Re-Open- 
ing the Case of the Abdominal Aortic Aneurysm. Cir- 
culation 13: 754-768 (May) 1956. 

3. DeBakey, M. E„ and Henley, W. S. : Dissecting Ane- 
urysm of the Aorta. Internat. Forum, 8: 116-118, 1960. 

4. Klass, A. A.: Embolectomy in Acute Mesenteric Occlu- 
sion, Ann. Surg. 134: 913-917 (Nov. I 1951. 

5. Derrick, J. R.. and Logan, W. D.: Mesenteric Arterial 
Insufficiency, Surgery 44: 823-827 (Nov.) 1958. 

6. Reich, N. E.: Occlusions of the Abdominal Aorta: A 
Study of 16 cases of Saddle Embolus and Thrombosis. 
Ann. Int. Med. 19: 36-59 (July) 1943. 

7. Burt, C. C. Learmonth, J., and Richards, R. L.: On 
Occlusion of the Abdominal Aorta. Edinburgh M. J. 
59: 65-93 (Feb.) 1952. 

8. Ewing. M. R. : Aortic Embolectomy. Brit. J. Surg. 38: 
44-51 (July) 1950. 

9. Randin, I. S.. and Wood. F. C. : The Successful Re- 
moval of a Saddle Embolus of the Aorta. Eleven Days 
After Acute Coronary Occlusion, Ann. Surg. 114:834-839 
I Nov.) 1941. 

10. Willman. V. L.. and Hanlon, R. : Safer Operation in 
Aortic Saddle Embolism, Four Consecutive Successful 
Embolectomies via the Femoral Arteries Under Local 
Anesthesia, Ann. Surg. 150:568-574 (Oct.) 1959. 

11. Belcher, J. R.. and Somerville, W.: Systemic Embolism 
and Left Auricular Thrombosis in Relation to Mitral 
Valvolotomy. Brit. M. J. 2: 1000-1003 (Oct. 22) 1955. 



318 



NORTH CAROLINA MEDICAL JOURNAL 



August. 19(30 



Diagnosis and Treatment of 
Intussusception in Infants and Children 



Louis Shaffner, M.D.* 
Winston-Salem 



Intussusception is the invagination or 
telescoping of a portion of bowel into the 
bowel distal to it. It occurs usually in the 
region of the terminal ileum, being of the 
ileo-colic type; but colo-colic, ileo-ileal, and 
the treacherous and complicated ileo-ileo- 
colic types are occasionally encountered. 

The mesenteric blood vessels are pulled in 
between the layers of bowel and subsequently 
obstructed by tension and pressure. The re- 
sult is a strangulating process of the intus- 
suscepted portion and a mechanical obstruc- 
tion of the innermost lumen from the result- 
ant edema of the bowel wall. 

If left untreated, 95 per cent of the pa- 
tients will die. The few who recover do so 
by a spontaneous reduction or a sloughing 
of the gangrenous portion into the distal 
bowel, with relief of the obstruction. 

Intussusception is an acute painful ab- 
dominal condition and a discussion of it fits 
in well with the other papers presented on 
this program. It is, however, unique among 
the subjects covered in that it occurs prin- 
cipally in infants and children. As such, 
the discussion of it can serve as a reminder 
of the value of modifying for infants and 
children the procedure of physical examina- 
tion usually followed in adults. 

Intussusception furthermore is a condi- 
tion about which there is no complete agree- 
ment as to the best form of treatment. 
Ravitch" 1 has emphasized again the value of 
a barium enema under hydrostatic pressure 
as the initial therapy prior to any operative 
approach. 

Our experiences with 22 cases at the 
North Carolina Baptist Hospital will be 
summarized. 

Diagnosis 

Some 80 to 90 per cent of reported cases 
of intussusception occurred in children un- 
der 2 years of age, the majority ranging 
between 3 and 11 months. The patients are, 
therefore, old enough to complain but too 
young to describe their complaints. 

The mother usually states that the baby 
had been entirelv well until suddenly he be- 



*From the Department of Surgery. Bowman Gray School 
of Medicine. Winston-Salem. N. C. 



gan to have severe attacks of "colic," char- 
acterized by an agonizing cry of pain, pallor, 
a drawing up of the legs upon the abdomen, 
and vomiting. This might last 30 seconds to 
a minute, followed by apparent relief for 
minutes to hours, only to be repeated again 
and again until the baby looked limp, refused 
all feedings, and perhaps became distended. 
A normal bowel movement might occur, and 
after several hours there may be some blood, 
bright red or the dark, so-called "currant 
jelly" type, mixed with the stools. 

It should be emphasized that blood in the 
stools is not an early manifestation, for when 
it does occur it is an indication of consider- 
able venous obstruction in the involved bow- 
el, causing ulceration and bleeding of the 
mucosa. The symptoms are suggestive 
enough of intussusception before blood ap- 
pears, yet experience has shown that the 
appearance of blood does not mean that the 
bowel is gangrenous and that resection will 
be mandatory. 

The important positive sign during exam- 
ination of the abdomen is the presence of an 
elongated or sausage-shaped, only slightly 
tender, mass anywhere along the course of 
the colon. This may vary in size with peris- 
taltic activity, or be constant in size and 
definitely tender, indicating more edema and 
a more severe impairment of the blood sup- 
ply. A relative emptiness of the right lower 
quadrant, known as Dance's sign, is difficult 
to interpret, but if present suggests that an 
elusive mass may be hiding either under the 
liver edge or under the left rib cage at the 
splenic flexure. 

Peristalsis will be that of small bowel colic, 
and when it is heard, the child will at the 
same time tighten his abdominal muscles 
and cry until the episode is passed. 

Method of Examination 
Examination of the "acute abdomen" in 
an inarticulate, uncooperative, frightened, 
crying, irritable, sick baby can be a difficult 
and unrevealing procedure unless the rou- 
tine is modified from that used in adults. 

A general inspection of the baby will re- 
veal by his color, attitude, and activity 
whether he is acutely ill and whether his 



August, 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



319 



abdomen is distended or a hernia protrudes. 
If the baby is lying quietly in his mother's 
arms when first seen, then is the opportune 
time to place the stethoscope gently on the 
abdomen to determine peristalsis and, if he 
remains quiet, to listen to the anterior chest. 

Gentle and light palpation with a warm 
hand comes next. If there is no distention, 
it is usually easy to determine the presence 
of muscle spasm or a palpable mass. It is 
gratifying to find that if this initial palpation 
is gentle, light, and slow, any response from 
the baby such as a whimper, a squirm, a 
facial wince, or a sudden tightening of the 
musculature is a reliable sign of tenderness 
beneath the palpating hand. These actions 
can speak as loudly as words to say, "That 
hurts." If at the first such sign the examiner 
removes his hand, the baby will usually be- 
come quiet again. More thorough palpation 
of the non-tender areas can then be repeated, 
and finally the tender area confirmed. 

Percussion of the abdomen can be as much 
a test for rebound tenderness as for tympany 
or shifting dullness. If done very gently, it 
too can localize the tender area by the same 
responses. 

But what if the baby is crying and tossing 
when first seen, and, as often happens, has 
been taken from his mother, disrobed, held 
naked on a cold table, and a thermometer 
thrust up his rectum? Or what if one gags 
his throat, pokes his ears, twists his neck, 
turns him over, and thumps his chest be- 
fore examining his abdomen? 

There is only one answer. The baby must 
be quieted down and relaxed before the ab- 
dominal examination can be satisfactory. 
Maybe a few minutes in his mother's arms 
will do it. If he isn't vomiting, maybe a 
bottle or a sugar nipple will do it. But it 
may also take a pentobarbital suppository 
or a subcutaneous injection of Demerol 
(1.0 mg. per pound) 20 or 30 minutes to 
do it. If such sedation seems necessary, it 
should be used for the good of everybody 
concerned. 

Certainly a complete examination should 
be done, but in an order and a manner that 
allows a thorough abdominal examination in 
a quiet, relaxed child. The final rectal exam- 
ination is done not only to check for blood 
but also for tender masses. At times the 
leading point of an intussusception, like a 
small cervix, can be felt within the rectal 
ampulla. 



Differential Diagnosis 

There are no other conditions that present 
the findings of a typical intussusception. 
But sometimes the signs of small bowel ob- 
struction are dominant, and the distention 
prevents palpation of the intussuscepted 
mass. An ulcerated Meckel's diverticulum 
alone or a polyp can cause bloody stools, and 
appendicitis and all forms of acute enteritis 
must be thought of. 

When the diagnosis of intussusception is 
suspected but no abdominal mass is palpable, 
a barium enema for diagnosis alone will 
settle the issue and at times will cure the 
disease. The retrograde flow of barium will 
slow at the leading point of the intussuscep- 
tion, then outline it with the "coiled spring" 
sign, and sometimes reduce it in seconds. 

Treatment 

Basically the treatment of intussusception 
is that of relieving an intestinal obstruction 
at the point of the obstruction. Supportive 
measures to correct dehydration and relieve 
intestinal distention should, of course, be 
started as soon as the diagnosis is made. 

The only controversy seems to be whether 
an initial trial at reduction by a barium en- 
ema under hydrostatic pressure is safe and 
effective. Even the opponents of such a trial' 2 ' 
admit they have seen barium enemas given 
primarily for diagnosis cause ready reduc- 
tions and obviate an operation. These have 
occurred principally in patients seen within 
24 hours of the onset of symptoms. 

Ravitch (1341 in urging the routine trial 
of this method, presents convincing evidence 
from Scandinavian and Australian clinics 
and from his own experience that it is ef- 
fective in 3 out of 4 cases and is attended 
by much less morbidity and mortality than 
operative treatment alone. He reports no 
deaths in 65 patients so treated, and in cases 
of successful reduction by the enema the 
hospital stay was only one-third as long as 
those requiring operation. 

He refutes the objections of others by 
pointing out that with his method irreduc- 
ible bowel will not rupture nor a gangrenous 
one be reduced. There is less trauma to the 
bowel itself than by manual reduction. There 
will be a correctable cause, such as a polyp 
or Meckel's diverticulum, in only 5 per cent 
of the patients, and none of these require 
immediate removal. If complete reduction 
is not successfully demonstrated, there is no 
delay ; surgical exploration is performed im- 
mediately through a McBurney incision. 



320 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1900 



Table 1 

Symptoms and Signs 

22 Cases 

No. PerCent 

Intermittent abdominal pain 22 100 

Vomiting 22 100 

Bloody stools 16 73 

Palpable abdominal mass 14 64 

Abdominal distention-obstruetion 4 18 

He finally stresses the point that this is a 
hospital surgical procedure and can be sim- 
ply compared to an initial attempt at a closed 
reduction of a fracture. If not successful, 
open reduction may be necessary. Physicians 
will refer suspected cases sooner, and par- 
ents will readily agree to early hospitaliza- 
tion if by so doing there is an excellent 
chance of cure without an operation. 

Technique 

Ravitch's method in the use of barium 
under fluoroscopic control may be summar- 
ized as follows: (1) Insert a 45 cc. Foley 
bag catheter in rectum; (2) maintain a 3- 
foot elevation of barium reservoir; (3) per- 
sist with constant pressure if progress made ; 
(4) proceed with surgical exploration if 
ileum is not well filled; and (5) instill pow- 
dered charcoal into the stomach if reduction 
is apparent. 

His criteria of reduction are: (1) free 
flow of barium into small bowel; (2) return 
of feces or flatus with barium; (3) disap- 
pearance of mass; (4) clinical improvement, 
and (5) recovery in stool of charcoal. 

Summary of Cases 

Twenty-two cases of intussusception in the 
pediatric age group have been seen at the 
North Carolina Baptist Hospital from 1946 
through 1959. This represents 20 patients, 
2 having been admitted twice for a recur- 
rence of the condition. There were 14 males 
and 6 females. Thirteen were between the 
ages of 3 months and 2 years, 6 from 2 to 4 
years of age, and 3 from 5 to 10 years of 
age. 

The predominant signs and symptoms are 
noted in table 1. The duration of symptoms 
from onset to initiation of treatment varied 
from four hours to four days. The correct 
diagnosis was suspected clinically in all pa- 
tients except the 4 showing predominantly 
the signs of small bowel obstruction. 

Our only death was in one of these, a 3 
year old girl who was admitted with a four 
hour history of intermittent abdominal pain 
and vomiting, preceded the day before by 
passage of a bloody stool without pain. The 
abdominal examination revealed no masses, 



Table 2 
Treatment 
(22 Cases) 
Nonoperative reduction 

Spontaneous 

Plain enema 



Barium enema 



3 
8 

4* 

15 



Total 

Operative treatment 

Exploratory (obstruction already reduced) .... 

Manual reduction 

Resection or exteriorization 

Total 

* 1 death: operative mortality 1% 

or tenderness, but peristaltic rushes were 
heard that coincided with apparent pain. No 
blood was found in the stools. A plain roent- 
genogram of the abdomen was not diagnos- 
tic. After a 24-hour delay during which 
symptoms progressed, a diagnostic barium 
enema revealed an intussusception in the 
cecum. At operation an ileo-colic mass was 
reduced, and a gangreous portion of ileum 
containing an ectopic pancreatic nodule was 
resected. Hyperpyrexia and convulsions de- 
veloped during the procedure and the patient 
died two hours later. An autopsy was not 
obtained. 

Only 15 of the cases required operation, 
table 2. The clinical diagnosis in the 4 that 
were reduced spontaneously or by plain en- 
emas was certain enough to be included in 
the group. Diagnosis of the other 3 was con- 
firmed at the time of reduction by barium 
enema. The one death gives an operative 
mortality of 7 per cent and an over-all mor- 
tality of 4.5 per cent. 

Table 3 

Etiology 

15 Operative Cases 

Antecedent diarrhea 

Hyperplastic Peyer's patch 

Meckel's diverticulum 

Ectopic pancreas in ileum 

Papilloma of cecum 

Mobile cecum 

Prominent ileo-cecal valve 

Recent bowel surgery 

Idiopathic 



.._ 2 



Probable etiologic factors in the 15 oper- 
ative cases are listed in table 3. The hyper- 
plastic Peyer's patches seemed to be the lead- 
ing points in 2 cases, and in each the appear- 
ance of the mesenteric nodes was compatible 
with a coincident diagnosis of mesenteric 
adenitis. 

Barium enema examinations were done in 
13 patients. The other 9 included those who 
improved spontaneously or after a plain 
enema and those who were considered can- 
didates for exploration for severe obstruc- 



August. 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



321 



Table 4 
Barium Enema in Intussusception 
Attempted reduction _ 11 

Successful — no surgery 3 — 21'', 

Successful — proved at surgery 2 

Unsuccessful — operative treatment 6 

tion. In only 11 was any attempt made to 
reduce the intussusception by hydrostatic 
pressure, table 4. This was successful in 
only 3 patients (27 per cent), symptoms 
having been present 12 hours in 2 and 4 
days in the third. In 2 additional cases op- 
eration disclosed complete reduction, even 
though the terminal ileum had not filled with 
barium. Symptoms had been present less 
than 12 hours in each of these cases. 

Comment 

The two recurrent cases are of interest. 
In one, the first episode occurred at 13 
months of age, and after an unsuccessful 
attempt at reduction by barium enema an 
ileo-ileo-colic type of intussusception was re- 
duced at operation. When similar symptoms 
recurred at the age of 3 years, exploration 
was done without a preliminary enema and 
an ileo-ileal type was found to have been re- 
duced spontaneously. 

In the other the first episode occurred at 
16 months of age, barium enema was unsuc- 
cessful, and an ileo-colic type of intussuscep- 
tion was easily reduced at operation. The 
intussusception recurred at the age of 2i/o 
years, was easily reduced by a barium en- 
ema, and the patient was discharged 48 hours 
later. Three months later she had a third 
episode of intermittent pain, vomiting, and 
passage of a grossly bloody stool during a 
12-hour period. She then improved spon- 
taneously, and four hours later examination 
of the abdomen was normal and barium en- 
ema showed no intussusception. A barium 
study of the small bowel was subsequently 
normal. When seen recently at age 14, she 
had had no further trouble. Undoubtedly, 
the third attack was due to another intus- 
susception which was reduced spontaneously. 

These 2 cases illustrate that a past history 
of an intussusception requiring operative 
reduction does not necessarily imply that a 
recurrent episode will demand another op- 
eration. A barium enema might prove a 
spontaneous reduction or effect a therapeu- 
tic one. 

This series of 22 cases is admittedly a 
■ small number from which to draw conclu- 
sions. Nevertheless, we certainly have had 
; no complications from trying reduction by 



barium enema, and the successful patients 
have gone home in less than three days. In 
retrospect several of our operative cases, 
including the fatality, might have been di- 
agnosed and treated sooner had a barium 
enema been done at the first suspicion of 
intussusception. 

Our radiologists have been reluctant to 
prolong or persist at any attempt at reduc- 
tion as long as Ravitch does. And our sur- 
geons have withheld exploration only when 
the evidence of complete reduction was quite 
convincing. Yet with this conservative ap- 
proach we have had some success and have 
done no harm. As we gain experience our 
percentage of reductions with barium enema 
may rise. The more we encourage early di- 
agnosis by requesting a barium enema in all 
suspected cases, the better chance we have 
to treat these babies safely, simply, and 
easily. 

Summary 

Intussusception should be suspected in 
any infant with a history suggestive of the 
sudden onset of small bowel obstruction. 

A satisfactory examination of the "acute 
abdomen" in an infant requires a modifica- 
tion of the order and manner of examination 
usually used in adults. The infant must be 
quiet and relaxed. 

Ravitch's method of an attempt at reduc- 
tion by barium enema under hydrostatic 
pressure has led to earlier diagnosis, suc- 
cessful treatment in 3 out of 4 cases, and a 
reduction in over-all morbidity. 

Twenty-two cases have been analyzed. 
Three of 11 intussusception were reduced 
by barium enema without operation. Out of 
15 operative cases there was one death, that 
attributable to a delay in diagnosis which 
could have been reached sooner if a barium 
enema had been done when first indicated. 

A barium enema in all suspected cases can 
lead not only to an earlier diagnosis, but also 
to an easier and simpler cure. 

References 

1. Ravitch, M. M. : Non-Operative Treatment of Intus- 
susception; Hydrostatic Pressure Reduction by Barium- 
Enema Under Fluoroscopic Control; Current Surgical 
Management, Philadelphia, W. B. Saunders Co., 1957. 
pp. 358-367. 

2. (a) Fox, P. P.: Intussusception: Surgical Treatment. 
S. Clin. North America 36: 1501-1509 (Dec.) 1956. (b) 
Gross, R. E. : The Surgery of Infancy and Childhood, 
Philadelphia, W. B. Saunders Co., 1933, pp. 281-300. 



322 



NORTH CAROLINA MEDICAL JOURNAL 



August, I960 



(c) Izant. R. J., Jr.. and Clatworthy. H. W.. Jr.: Sur- 
gical Treatment of Intussusception: Current Surgical 
Management. Philadelphia. W. B. Saunders Co.. 1957. 
pp. 349-357. (d) Swenson. Orvar: Pediatric Surgery. New 
York. Appleton-Century-Crofts, Inc.. 1958, pp. 328-340. 
If) Potts. W. J.: The Surgeon and the Child. Phila- 
delphia, W. B. Saunders Co., 1959, pp. 167-170. 



:i. Ravitch, M. M., and McCune. R. M., Jr.: Reduction of 
Intussusception by Barium Enema, Clinicpl and Ex- 
perimental Study, Ann. Sure. 128:904-917 'Nov.) 1948. 

4. Ravitch. M. M.: Reduction of Intussusception by Ba- 
rium Enema, Surg. Gyn. Obst. 99:431-436 (Oct.) 1954. 



The Diagnosis and Treatment of Acute Diverticular 

Disease of the Colon 

E. Jackson Dunning, M.D., F.A.C.S. 
Charlotte 



Diverticula of the colon are of two types : 
congenital and acquired. They are separate 
entities. The congenital diverticulum is a 
true diverticulum and therefore contains all 
the layers of the normal colon wall. This 
type is rare, is usually solitary, appears most 
frequently in the cecum, and seldom causes 
symptoms unless acutely inflamed' 1 '. The 
acquired variety (fig. 1), being by-products 
of degeneration, are false diverticula ; they 
are usually multiple and usually appear after 
40 years of age, when the incidence in- 
creases'- 1 . These diverticula are found most 
often in the sigmoid colon and occur with 
diminishing frequency from the left side of 
the colon to the right side (:,) . Predisposing 
factors — for example, narrowing, spasm, 
stasis, and increased intraluminal pressure 
— are most pronounced in the sigmoid' 4 '. 
This probably also accounts for the fact that 
the inflammation of the diverticula usually 
occurs only in the sigmoid and rarely in any 
other segment of the colon' 3 "- 5 '. 

It has been said that diverticulosis coli 
will be found in 5 to 10 per cent of people 
who undergo a barium enema, and that 
about 15 per cent, or 8 patients in 1,000, will 
probably have some type of diverticulitis' 3 "' 6 '. 
Undoubtedly the incidence of diverticular 
disease and its complications will steadily 
increase with our lengthening life span 27 '. 
The more diverticula present in the colon, 
the greater the chance of developing some 
form of diverticulitis, but the age of onset of 
diverticulosis does not influence the likeli- 
hood of the onset of inflammation'* 1 . 

Classification 

Diverticular disease of the colon, and of 
the sigmoid colon in particular, can give rise 
to a number of acute processes which should 
be considered : 

1. Acute sigmoiditis' 1 ". 



This process may progress to frank 
peritonitis, or obstruction, or pericolic 
abscess formation. 

2. Perforation of a diverticulum with or 
without inflammation' 1 '". 

3. Hemorrhage. 

Bleeding may be acute and massive 
with or without diverticulitis' 111 . 

4. Acute diverticulitis with small bowel 
obstruction. 

5. Acute diverticulitis with fistula or 
sinus formation. 

6. Acute diverticulitis with cancer or con- 
fused with cancer. 

Obviously, the complications of diverticu- 
losis coli are rarely so distinctly set apart 
clinically; rather, the involvement or changes 
in any given case may encompass one or all 
of these pathological processes. Also it 
should be stated that any of these clinical 
pictures may appear without the slightest 
suggestion of prior colon disease' 11 '". 

Diagnosis 

1. Acute sigmoiditis: The typical picture 
of acute diverticulities or acute sigmoiditis 
is that of a middle-aged, obese, constipated, 
sedentary individual with pain in the left 
lower quadrant of the abdomen' 12 ' or left 
iliac fossa (3b) . A history of diverticulitis is 
helpful, for 45 per cent of patients who have 
one attack of diverticulitis will have another 
attack' 131 . The pain and signs may be right- 
sided if the redundant and inflamed colon 
lies to that side. Also, diarrhea may be a 
complaint or diarrhea alternating with con- 
stipation. 

Examination reveals the objective evi- 
dence of infection — for example, the eleva- 
tion of temperature, pulse rate, and white 
blood count plus the signs of intraperitoneal 
inflammation : abdominal distention, dimin- 
ished peristaltic activity, abdominal tender- 



August, 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



323 




Fig. 1. Photomicrograph (x 1) of an acquired di- 
verticulum of colon. 

ness, rebound tenderness in the lower part 
of the abdomen, muscle-guarding over the 
sigmoid, and possibly a palpable sausage- 
shaped mass. The patient's age — that is, 
whether child or adult — and the origin of 
the pain further help to distinguish this 
process from appendicitis. In appendicitis 
the pain characteristically begins above the 
umbilicus and is likely to be associated with 
nausea and vomiting, while the pain of sig- 
moiditis originates below the umbilicus and 
is less likely to be accompanied by nausea 
and vomiting 1 ' 1 ". In diverticulitis the pain 
may come and go over a period of weeks. 
Salpingitis, tubo-ovarian abscess, ovarian 
tumors, strangulated hernia, sigmoid volvu- 
lus, and mesenteric thrombosis are diag- 
noses which should be considered. A small, 
carefully administered barium enema is the 
best single diagnostic test' 12 '. 

2. Perforation: Free perforation of a di- 
verticulum of the colon is much more com- 
mon than generally realized and usually 
happens with little or no warning 171 ". The 
pain produced is severe and knife-like, and 
may radiate to the back, hip, thigh, anus, 
or genitalia' 12 '. Typically it is associated 
with nausea, vomiting, and distention, with 
the development of severe intraperitoneal 
reaction such as that seen in the rupture of 
any other hollow viscus. An upright chest 
film will often show the subphrenic air (fig. 
2) and narrow the diagnosis to rupture of 
peptic ulcer or diverticulum. A good history 
of any prior difficulty, together with the 
point of major abdominal tenderness, should 
■ aid in making the proper diagnosis. 

3. Hemorrhage: Bleeding in diverticulosis 
coli has been reported in from 4 to 28 per 





Fig. 2. Upright roentgenogram of the chest show- 
ing subphrenic air accumulation from perforation 
of colon diverticulum. 

cent of the patients, but the number exhibit- 
ing massive hemorrhage is much smaller' 11 " 1 . 
Bleeding from other benign colon and ano- 
rectal lesions must be ruled out by barium 
enema and sigmoidoscopic examination, but 
it is especially important to rule out malig- 
nancy as a source of hemorrhage. Earley (Ub) 
has compiled from his experience and others 
the following criteria for concluding that 
the bleeding arises from diverticular dis- 
ease: 

1. Passage by rectum of bright or dark 
blood ; 

2. Sigmoidoscopy, barium enema, and air 
contrast studies showing diverticular 
disease and excluding other potentially 
bleeding lesions ; 

3. Stomach and small intestine normal to 
x-ray visualization ; 

4. Normal coagulability of blood. 

4. Acute diverticulitis with small bowel 
obstruction : 

This complication has not been adequately 
stressed in discussions of diverticulitis' 71> - 9| . 
The clinical picture produced is one of acute 
sigmoiditis together with the picture of small 
bowel obstruction, — namely, nausea, vomit- 
ing, cramp-like pains, abdominal distention, 
rushes of peristalsis, and fluid-air levels in 
dilated small bowel on erect x-ray films of 
the abdomen"". This problem must be dis- 
tinguished from the myriad of causes of 
small bowel obstruction, especially those 
with associated intraperitoneal infection. 

5. Acute diverticulitis with fistula or sinus 
formation: The formation of a vesico-colic 
fistula (fig. 3) may be heralded by symp- 
toms of cystitis' 2 - !1> , and even after the rup- 



:m 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 




Fig. 3. Barium enema roentgenogram revealing 
extensive diverticulosis of sigmoid colon and air 
in (he bladder as a result of a vesicolonic fistula. 

ture into the bladder has taken place the 
patient's symptoms are largely directed to 
the genitourinary tract 14 '. Cripps' 151 has 
stated that inflammatory lesions more fre- 
quently cause sigmoidovesical fistulas than 
do malignant lesions. Fistulas between the 
colon and affixed small bowel may occur, with 
resultant abdominal cramps and diarrhea, 
or the inflammatory process may burrow to 
the skin to form a colocutaneous sinus. 

6. Acute diverticulitis and cancer: Al- 
though the simultaneous occurrence of these 
two processes is rare'"' 7 " 1 , the problem of dif- 
ferentiation arises often. The problem has 
been touched on under "Hemorrhage," for 
here the suspicion of malignancy is great. 
The distinction may also be difficult in the 
other classes — for example, acute sigmoid- 
itis with obstruction, or even perforation. 
X-ray examination is the best method of es- 
tablishing the true diagnosis, for there are 
some very definite differences in the appear- 
ance of malignancy as contrasted with that 
of the complications of diverticulosis 14 '. 
Even so, in a high percentage of cases the 
diagnosis is not known until operation or 
even until a microscopic report is rendered 
.71.. i::, p or this reason the colon specimen 
should be opened in the operating theater 
to be certain that a malignancy has not been 
overlooked and inadequately resected. 



Treatment 

Treatment in any case of acute diverticu- 
lar disease must be sensibly individualized, 
because, as stated earlier, any one case may 
present some aspect of any or all of our arbi- 
trary classification. 

1. Acute sigmoiditis without sufficient re- 
action to produce either paralytic ileus or 
progression or obstruction can be treated 
by a nonoperative regimen such as bed rest, 
antispasmodics, oral liquids, stool softeners, 
and intestinal antiseptics. The preferred 
antibiotics range from sulfasuxidine to a 
combination of penicillin-streptomycin. If 
the condition progresses under this program, 
therapy must be stepped up to nothing in- 
gested by mouth, nasogastric suction, paren- 
teral fluids, parenteral antispasmodics, and 
parenteral antibiotics. If the inflammatory 
process is checked, prophylactic resection 
should be seriously considered. If on the 
other hand the process is not checked and 
further complications loom, a loop colostomy 
should be carried out in the right transverse 
colon with elective sigmoid resection in four 
to eight weeks. 

Whenever a case of acute diverticular dis- 
ease progresses to the point that a colostomy 
is necessary, then the involved bowel should 
be resected before the colostomy is closed 15 "' 
iia, i3, if.. At resection it is not necessary to 
remove all of the colon containing diverti- 
cula, but it is essential that the entire sig- 
moid be removed lest residual sigmoid di- 
verticula lead to recurrent diverticulitis' 171 . 

One other operative approach to acute sig- 
moiditis needs to be mentioned : the acute 
sigmoiditis found unexpectedly at operation. 
In this situation several methods of handling 
diseased bowel are available: an exteriori- 
zation procedure, formation of a proximal 
colostomy, or a delayed one-stage resection 
after preparation. 

2. Perforation of a diverticulum of the 
colon is best treated by a proximal colostomy 
and drainage of the pelvis. No effort should 
be made to track down the exact spot of 
leakage with an attempt to oversew the 
opening in inflamed and necrotic tissues. Ex- 
teriorization of the diseased colon segment 
has been carried out, and even a nonopera- 
tive technique has been used, but proximal 
colostomy and drainage is safest. Again, 
once the diverticular disease has progressed 
to the point of rupture, resection should be 
the ultimate goal. 



August, 19G0 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



325 



3. Hemorrhage from diverticular disease 
with or without inflammation will often sub- 
side on nonoperative measures 11 "'. This then 
allows for an elective resection on a proper- 
ly prepared bowel. A nonoperative measure 
which may produce a dramatic cessation of 
bleeding is the barium enema llS) . Presum- 
ably the barium enters the offending diverti- 
cula and produces a tamponade effect. The 
minority of patients who do not stop bleed- 
ing on a nonoperative approach will, of 
course, require an emergency colon resec- 
tion. These are usually older patients (Ub) . 

4. Acute diverticulitis with small boivel 
obstruction must be recognized and not 
treated by proximal colostomy alone for ob- 
vious reasons' 91 . Intensive nonoperative 
treatment may be condoned for 24 or even 
48 hours if the obstruction seems to be par- 
tial and possibly due to exudation and edema. 
If there is no relief of the obstruction or if 
the obstruction recurs, it is necessary to 
form a colostomy and free the small bowel 
obstruction. 

5. Acute diverticulitis with fistula or sinus 
formation should be treated by a proximal 
colostomy and eventual resection of the dis- 
eased colon. Simple dissection of a colo-cut- 
aneous sinus or a colon fistula with closure 
invites a recurrence. Also, to close the prox- 
imal colostomy without resecting the dis- 
eased colon in cases of fistula and sinus in- 
vites recurrence 113 '. 

6. Acute diverticiditis and cancer produce 
a much greater sense of urgency to proceed 
to wide resection of the involved bowel. Ear- 
ly proximal colostomy may diminish the in- 
flammation more quickly than a nonopera- 
tive approach, and resection may be carried 
out within two to three weeks, leaving the 
proximal colostomy as a protection against 
suture line leakage. 

Summary 
Acute effects or complications of diverti- 
culosis coli have been arbitrarily divided 
into : acute sigmoiditis, perforation, hemor- 
rhage, acute diverticulitis with small bowel 
obstruction, acute diverticulitis with sinus or 
fistula formation, and acute diverticulitis 
with associated malignancy. Some sugges- 
tions have been made as to the methods of 
diagnosing and treating these complications. 
The nearest common denominator seems to 
be that the more frequently we resect the 
colon in symptomatic, progressive diverticu- 
lar disease, the less often these complications 
will have to be treated. 



References 

1. (a) Degenshein, G. A.: Diverticulitis of the Right Colon. 
A. M. A. Arch. Surg. 76: 564-568 (April) 1958. (b) Mann, 
R. W.: Solitary Cecal Diverticulitis. A. M. A. Arch. 
Surg. 76: 527-529 (April) 1958. (c) Zinninger. M. M. : 
Dlvertlculosis and Diverticulitis of the Colon, Am. 
Surgeon 22: 683-695 (Aug.) 1956. 

2. Littlefleld, J. B.: Surgical Complications of Diverti- 
culitis and Dlvertlculosis of the Sigmoid Colon, Am. 
Surgeon 23: 272-277 (March) 1957. 

3. (a) Smithwick, R. H.: Experiences with the Surgical 
Management of Diverticulitis of the Sigmoid. Ann. 
Surg. 115: 969-985 (June) 1942. (b) Spriggs, E. I., and 
Marxer, O. A.: Multiple Diverticula of the Colon, Lancet 
1: 1067-1074 (May 21) 1927. 

4. Mayo, C. W., and Blunt, C. P.: The Surgical Manage- 
ment of the Complications of Diverticulitis of the 
Large Intestine: Analysis of 202 Cases, S. Clin. North 
America 30: 1005-1012 (Aug.) 1950. 

5. (a) Boyden, A. M.: The Surgical Treatment of Diverti- 
culitis of the Colon, Ann. Surg. 132: 94-109 (July) 
1950. (b) Jones, T. E.: Diverticulitis and Diverticu- 
losis of the Colon, S. Clin. North America 19: 1105- 
1117 (Oct.) 1939. 

6. Jones, T. E. : Surgical Treatment of Diverticulitis, Ohio 
State M. J. 34: 1225-1223 (Nov.) 1938. 

7. (a) McGowan, F. J., and Wolff, W. I.: Diverticulitis 
of the Sigmoid Colon, Gastroenterology 21: 119-132 
(May) 1952. (b) McMillan, F. L., and Jamieson, R. W.: 
Trends in the Surgical Treatment of Diverticulitis of 
the Colon, S. Clin. North America 35: 153-173 (Feb.) 
1955. 

8. Horner, J. L.: Natural History of Diverticulosis of the 
Colon, Am. J. Dig. Dis. 3: 343-350 (May) 1958. 

9. Bodon, G. R., and Lapuz, B.: Acute Small Bowel Ob- 
struction with Sigmoid Diverticulitis and Its Manage- 
ment, Surgery 44: 631-635 (Oct.) 1958. 

10. Fitts, W. T., Jr., and Anderson, L. D. : Spontaneous 
Perforation of Sigmoid Colon in Presence of Diverticu- 
losis; Report of 2 Cases Without Evidence of Inflamed 
Diverticula, J. A. M. A. 152: 1427-1428 (Aug. 8) 1953. 

11. (a) Bacon, H. E., and Valiente, M. A.: Surgical Man- 
agement of Diverticulitis, Am. J. Surg. 91: 178-183 
(Feb.) 1956. (b) Earley, C. M., Jr.: The Management 
of Massive Hemorrhage from Diverticular Disease of 
the Colon, Surg. Gynec. & Obst. 108: 49-60 (Jan.) 1959. 

12. Morton, J. J., Jr.: Diverticulitis of the Colon, Ann. 
Surg. 124: 725-745 (Oct.) 1946. 

13. Colcock, B. P.: Surgical Management of Complicated 
Diverticulitis, New England J. Med. 259: 570-573 (Sept. 
IS) 1958. 

14. (a) Lynn, T. E., Farrell. J. I., and Grier, J. P.: Sig- 
moidovesical Fistula Secondary to Diverticulitis, A. M. 
A. Arch. Surg. 76: 956-962 (June) 1958. (b) Judd, E. S., 
and Smith, M. P.: Present Trends in Surgical Treat- 
ment of Diverticulitis, S. Clin. North America 37: 1019- 
1027 (Aug.) 1957. 

15. Cripps, H.: Cited by Mayfield, L. H., and Waugh. 
J. M.: Sigmoidovesical Fistulae Resulting from Di- 
verticulitis of the Sigmoid Colon, Ann. Surg. 130: 
186-199 (Aug.) 1949. 

16. Smithwick, R. H.: Surgical Treatment of Diverticul- 
itis of the Sigmoid, Am. J. Surg. 99: 192-205 (Feb.) 1960. 

17. Turnbull, R. P.: Personal Communication. 

18. Meyer, T. L. : Massive Hemorrhage from Sigmoid Di- 
verticula, Am. J. Surg. 99: 251-252 (Feb.) 1960. 

19. Colcock, B. P.: Surgical Treatment of Diverticulitis, 
Am. Surgeon 24: 738-740 (Oct.) 1958. 



326 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



Diagnosis and Treatment of Acute Cholecystitis 



William W. Shingleton, M.D.* 
Durham 



Because of the rapidly increasing number 
of older people in the population, the inci- 
dence of complications arising from chronic 
biliary tract disease is on the increase. 
Among these complications is acute cholecy- 
stitis. For example, during a 26-year period 
(1932-1958) at the New York Hospital, 
5,037 operations were performed for non- 
malignant biliary tract disease, 1,028 of 
which were for acute cholecystitis 111 . It has 
been estimated that approximately 10 per 
cent of the entire population have gallstones, 
and the incidence is about four times as fre- 
quent in women as in men' 2 '. Approximately 
10 per cent of these patients may be ex- 
pected to develop acute cholecystitis. 

The etiology of gallstone formation is still 
unknown in spite of intensive research. 
Neither is the mechanism of the development 
of acute cholecystitis completely understood. 
A common clinical finding in acute cholecy- 
stitis, however, is the presence of an im- 
pacted stone producing obstruction of the 
cystic duct. Although acute cholecystitis may 
occur in the absence of cholelithiasis, this is 
the exception and not the rule. Most stu- 
dents of the disease feel that with obstruc- 
tion of the cystic duct, the concentration of 
bile in the obstructed gallbladder is in- 
creased, giving rise, initially, to a chemical 
inflammatory reaction, resulting in edema of 
the wall of the organ. This, in turn, leads 
to impairment of the circulation and event- 
ual invasion of the damaged tissue by bac- 
teria. Although bacteria can conceivably 
enter the organ from the blood stream by 
direct invasion from adjacent organs or 
originate from the bile, evidence suggests 
that the bacterial invasion occurs most often 
via the lymphatic vessels' 21 . Bacteria can be 
cultured from approximately 50 per cent of 
acutely inflamed gallbladders, and the most 
common organisms recovered are Esche- 
richia coli and streptococci 1 '". 

Diagnosis 

Cholecystography provides the single most 
helpful procedure in establishing the pres- 
ence or absence of chronic gallbladder dis- 
ease. The most helpful diagnostic procedure 



'From the Department of Surgery. Duke University Med- 
ical Center, Durham, North Carolina. 



in acute cholecystitis, however, is the phys- 
ical examination of the patient. The symp- 
toms are strikingly uniform in a majority 
of cases. 

The attack usually begins with the devel- 
opment of moderately severe epigastric or 
right upper quadrant pain, often radiating 
to the back, scapula area, or right shoulder. 
The pain is usually quite severe, requiring 
narcotics for relief, and is usually associated 
with nausea and vomiting. Chills and fever, 
or fever alone, develop during the attack. 

The physical signs consist of tenderness, 
muscle spasm, and rebound tenderness in the 
right upper quadrant ; there is often a pal- 
pable mass in this area, representing the 
distended gallbladder. A mild jaundice is 
often present. If perforation of the gallblad- 
der has occurred, a palpable mass represent- 
ing a walled-off abscess, or generalized peri- 
toneal signs representing a bile peritonitis, 
will be present. 

Laboratory studies in acute cholecystitis 
reveal a leukocytosis and, in some cases, mild 
elevation of serum bilirubin. Serum amylase 
may be elevated in cases associated with pan- 
creatitis, which is usually of the edematous 
variety. An intravenous cholangiogram may 
result in visualization of the common duct 
but non-filling of the gallbladder' 4 '. 

Acute cholecystitis must be differentiated 
from other acute abdominal inflammatory 
conditions, such as perforated duodenal ul- 
cer, acute cholecystitis, acute pancreatitis, 
acute diverticulitis, hepatitis, and abscess of 
the liver. Renal disease and coronary throm- 
bosis also should be included in the differ- 
ential diagnosis. 

Treatment 

The patient with acute cholecystitis may 
be treated with or without operation during 
the acute attack. Although certain physi- 
cians may, by choice, treat all their cases by 
one or the other of the two methods, many 
now hold that the method chosen be fitted to 
the individual patient, based upon consider- 
ation of a variety of factors bearing upon 
the mortality and morbidity of the disease. 
Some of the factors are: 

1. The duration of symptoms when the 
patient is first seen 



AuKust, 1960 



SYMPOSIUM ON ACUTE CONDITIONS OF THE ABDOMEN 



327 



2. The accuracy of diagnosis 

3. Age of the patient 

4. Presence of associated disease 

5. Severity of the disease when patient 
is first seen. 

Prevailing opinion holds that operation 
can be carried out in a majority of patients 
during the early stages (48 to 72 hours) of 
acute cholecystitis with a low mortality and 
morbidity, and with a shorter hospital stay. 
Large groups of patients treated by both 
surgical and nonsurgical methods with no 
striking difference in mortality have been 
reported. Thus Bartlett 1 " reported on 592 
patients treated surgically and 124 patients 
treated nonsurgically at the Massachusetts 
General Hospital with a mortality rate of 3 
per cent in the surgical cases and 4 per cent 
in the nonsurgical cases. Becker" ; ' reported 
on 679 patients treated surgically and 381 
patients treated nonsurgically at the Charity 
Hospital in New Orleans. The mortality rate 
in the surgical group was 6.6 per cent, and 
in the nonsurgical 5.5 per cent. 

The types of operative procedures usually 
employed are cholecystectomy, cholecystec- 
tomy and choledochostomy, and cholecystos- 
tomy. The incidence of exploration of the 
common duct during operation as reported 
by several authors'"'' 71 varies between 10 
and 40 per cent. It is suggested that the 
following conditions constitute indications 
for exploration of the common bile duct dur- 
ing operation for acute cholecystitis : 

1. Palpable stone in duct 

2. Jaundice with bilirubin above 5 mg. 
per 100 ml. 

3. Associated pancreatitis. 

It should be pointed out that if the inflam- 
matory reaction around the common duct 
abscures anatomic identification of struc- 
tures in the area, exploration of the common 
duct, even when indications exist, may be 
deferred and performed as a secondary pro- 
edure later. 

Cholecystostomy is used in the acutely ill 
3r poor risk patient who fails to respond to 
lonoperative treatment. The procedure can 
ae carried out under local anesthesia with 
only slight risk and may be life-saving in this 
eriously ill group. 

The complication to be avoided, if at all 
possible, is perforation of the gallbladder 
prior to surgical intervention. At one time 
this complication was considered rare ; how- 
3ver, the several reported series suggests 
that it develops in 10 to 25 per cent of pa- 



tients with acute cholecystitis" 1 . Three types 
of perforations occur: (1) perforation into 
the free peritoneal cavity, the most serious; 
(2) perforation with walled-off abscess, the 
least serious; and (3) perforation into an 
adjacent viscus, often the colon. The man- 
agement of perforation with generalized 
peritonitis is cholecystectomy with drainage 
of the peritoneal cavity. The treatment of 
perforation with localized abscess is initially 
a nonoperative program including stomach 
suction, antibiotics, and intravenous fluids. 
Interval cholecystectomy should be carried 
out later. Treatment of perforation into an 
adjacent viscus consists of cholecystectomy 
with repair of the perforation into the in- 
volved viscus. 

The principles of nonsurgical treatment 
are bed rest, stomach suction, antibiotics, 
and intravenous fluids and electrolytes. This 
treatment should be continued until the pa- 
tient is pain-free and the temperature and 
leukocyte count have returned to normal. 

An interesting approach with which the 
author has had no experience is the use of 
procaine block of perirenal or splanchnic 
nerve. A Russian surgeon, Ossipov' 91 , has 
recently reported on this technique. It is 
my opinion that, as in acute pancreatitis, 
regional procaine injection in acute cholecys- 
titis favorably influences the acute inflam- 
matory process. Patients are initially given 
a paranephric procaine block, some of which 
respond (no figures given) ; those who do 
not respond are operated on during the first 
24 hours, under local anesthesia. Under this 
method there were 9 deaths in 285 opera- 
tions, a mortality rate of 3.1 per cent. 

Experience at Duke Hospital 

The charts of 100 consecutive cases of 
acute cholecystitis treated at Duke Hospital 
from 1953 through 1959 were recently re- 
viewed. Fifty-one patients were operated 
on during the acute attack, and 49 patients 
were treated nonoperatively. Thirty-one 
were males and 69 were females. Forty-two 
patients were under 50 and 58 patients were 
over 50 years of age. Twenty-one patients 
were over 70 years of age and seven patients 
were over 80. Operation was carried out in 
the following circumstances : 

1. In patients seen early in the disease 
(48 hours) who were good or reason- 
able surgical risks 

2. In patients where diagnosis was in 
doubt 



:;l'n 



NORTH CAROLINA MEDICAL JOURNAL 



August, 10(30 



4. 



In patients who did not respond or 
grew worse during medical treatment 

In patients who exhibited signs of im- 
pending or actual perforation of the 
gallbladder. 



The results of treatment and type of op- 
erative procedure used in the 100 cases of 
acute cholecystitis are shown in table 1. One 
of the deaths in the surgically treated group 
resulted from cardiac arrest which developed 
during operation, and autopsy showed, in 
addition to acute cholecystitis, marked cor- 
onary atherosclerosis. The other death in 
the surgical group occurred in a patient who 
had acute cholecystitis five days following 
inferior vena caval ligation for multiple pul- 
monary embolism. The patient was operated 
on 24 hours following the onset of abdom- 
inal symptoms and was found to have a per- 
forated gallbladder, which was removed. The 
patient died two days later, presumably from 
peritonitis ; no autopsy was obtained. 

The one death in the nonoperatively 
treated group occurred in a patient who was 
admitted to the hospital with signs of gen- 
eralized peritonitis and who died 24 hours 
later. The cause of the peritonitis was not 
established prior to death. Autopsy revealed 
a generalized bile peritonitis from perfora- 
tion of an acutely inflamed gallbladder. 

Certain associated diseases encountered 
in the 100 patients treated for acute cho- 
lecystitis are of interest. Five patients had 
acute pancreatitis. All these patients had a 
serum amylase level above 500 Somgyi units 
when first seen before operation. Operation 
was deferred in all these patients during the 
acute attack. Three patients were found to 
have carcinoma of the pancreas in conjunc- 
tion with acute cholecystitis. In one case 
acute cholecystitis developed after an opera- 
tion for an unassociated condition. 

Summary and Co)iclusions 

A review of the diagnostic features of 
acute cholecystitis is presented. Diagnosis 
can be established in a majority of patients 
early in the acute attack. The most helpful 
diagnostic procedure is accurate observation 
of physical signs associated with the disease. 
Intravenous cholangiography performed 
during an acute attack may be helpful. 



No. 




eaths 


Mortality 


1 


2', 


2 


■I'; 


1 














1 





Table 1 
Mortality in Surgical and Nonsurgical Treatment 
of Acute Cholecystitis 
No. 

Treatment Cases 

Nonoperative _ 49 

Operative 51 

Cholecystectomy 40 

Cholecystectomy 6 

Cholecystectomy \ , 

Choledochostomy / 

Cholecystostomy 5 

Results of treatment in acute cholecysti- 
tis, as reported in current medical literature, 
suggest that patients can be treated both op- 
eratively and nonoperatively with a similar 
mortality. 

A review of 100 consecutive patients with 
acute cholecystitis treated at Duke Hospital 
from 1953 through 1959 shows that approx- 
imately one half of the patients were op- 
erated upon during the acute attack, and 
the other half were treated nonoperatively 
Mortality rates were similar in the two 
groups. The indications for operation and' 
management of complications are discussed 
It is concluded that treatment of patients 
should be individualized, and that the form 
of treatment chosen should be that which is 
best suited to the specific situation in each! 
individual case. 

References 

1. Glenn. P.: A 26 Year Experience in the Surgical Treat 
ment of 5.037 Patients with Nonmallgnant Biliarj 
Tract Disease, Surg.. Gynec. & Obst., 109: 591. 1959 



: 
Iter 



2. Cole, W. H.. and Elman, R: Textbook of Surgery 
New York, Appleton-Century-Crofts. Inc. 

3. Illingworth, C. F. W. Types of Gallbladder Infection 
Brit. J. Surg.. 15: 221. 1928. 

4. Sparkman. R. S.. and Ellis. P. R.: Intravenous Cho 
lecyst-Cholangiography in Emergency Abdominal Di 
agnosis, Ann. Surg. 143: 416-421 (March) 1956. 

5. Bartlett. M. K.. Quinby. W. C. and Donaldson, G. A. 
Surgery of the Biliary Tract: Treatment of Acute Cho 
lecystltis. New England J. Med. 254: 200-205 (Feb. 2: 
1956. 

6. Becker. W. F.: Powell. J. L.; Turner. R, J.: A Clinica; 
Study of 1060 Patients with Acute Cholecystitis. Surg.i 
Gynec. & Obst. 104:491. 1957. 

7. (a). Boyden. A. M.: Acute Gallbladder Disease and th 
Common Duct, A. M. A. Arch. Surg. 70: 374-378 (March 
1955. 

(b). Dunphy, J. E.. and Ross. F. P.: Studies in Acut; 
Cholecystitis: Surgical Management and Results, Sur 
gery, 26: 539-547 (Sept.) 1949. 

ic). Glenn. F. : Common Duct Exploration in Acut 
Cholecystitis, Surg,. Gynec, and Obst., 104: 190. 195' 

8. Pines, B.. and Rabinovltch, J. : Perforation of the Gall 
bladder in Acute Cholecystitis. Ann. Surg. 10: 170-17 
(Aug.) 1954. 

9. Osipov, B. K.: The Surgeon's Tactics in the Treatmen 
of Acute Cholecystitis, Surgery 46: 507, 1959. 



!k 

[mli 
il 

a ci 
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torn; 









August, 1960 



329 



Acute Surgical Conditions 
Associated with Pelvic Endometriosis 



Robert A. Ross, M.D.* 
Chapel Hill 



The problem of endometriosis deserves 
deliberate consideration in a symposium 
dealing with acute surgical conditions of the 
abdomen. The "acute abdomen" generally 
is well understood and its importance recog- 
nized. Though the qualified surgeon is capa- 
ble of meeting emergencies as they arise, 
anticipating the correct diagnosis allows for 
I better preoperative care, better definitive 
I measures, and greater assurance that the 
9 patient will be maintained as a normal an- 
> atomic, biologic, and psychologic woman. 

Diagnostic Criteria 
The compelling reason for placing a case 

oil of endometriosis in the category of surgical- 
ly acute conditions would probably be one 
or a combination of several symptoms and 
findings : Intra-abdominal bleeding, intesti- 
nal obstruction, lower abdominal infection, 
bleeding from the urinary tract, and rectal 
bleeding are the most common in the acutely 
ill patient. The patient would likely be in 
the 20- to 40-year age group ; she would give 
a history of increasing dysmenorrhea or ac- 
quired dysmenorrhea ; the menstrual cycle 
probably would have been altered ; if mar- 
ried, she might give a history of sterility ; 
previous uterine currettement or pelvic op- 
erations are not uncommon. The patient 
must have or have had a uterus and func- 

. tioning ovarian tissue in order to have en- 

d dometriosis ; however, intestinal obstruction 
can occur after castration or hysterectomy 
in patients who have had proven endometri- 
osis. 

The acute symptom or symptoms are eas- 
ier to explain than those of chronic or pro- 

;: gressing pelvic endometriosis. A transplant 
to the ovary can rupture, giving signs and 

..symptoms similar to an ectopic pregnancy 

:i or bleeding from a ruptured graffian follicle ; 
or it can become twisted, thus actually be- 

'".'', coming a twisted ovarian cyst with the re- 
lated complications : old blood and cellular 

; material can escape from an area of endom- 
etrial transplants and give all the evidence 

: '~; of acute appendicitis or salpingitis, or such 



*From the Department of Obstetrics and Gynecology, Uni- 
versity of North Carolina School of Medicine. Chapel Hill. 



areas can themselves become infected. Large 
and small intestines can become adherent to 
endometrial nodules with resulting intestinal 
obstruction, or the process can involve the 
bowel wall, usually rectosigmoid, and grad- 
ually produce obstruction. In two instances 
we have been confronted with hematuria 
and ureteral pain with symptoms similar to 
renal calculus and have found endometrioma 
of the broad ligament and pelvic brim with 
hemorrhage. 

Abdominal palpation or auscultation yields 
little that is distinctive. Pelvic examination, 
however, may disclose something that could 
suggest pelvic endometriosis. Tenderness 
and "beading" of the uterosacral ligaments 
is a common finding, and there is usually 
more fixation of the uterus and adnexae 
than one finds certainly in appendicitis or in 
a patient with initial salpingo-oophoritis. 
Although bilaterality is common in the dis- 
ease, usually one ovary and tube is more ad- 
herent than the other. The rectovaginal sep- 
tum may be obliterated, is unusually tender, 
or perhaps has findings similar to ruptured 
ectopic pregnancy. Rarely, a suggestive spot 
is encountered on the cervix or vaginal mu- 
cosa that would add to the suspicion of 
endometriosis, but this sign is uncommon. 

Treatment 
The management of these acute complica- 
tions of endometriosis is surgical, but con- 
servative treatment is usually possible. The 
conservation of ovarian tissue and an at- 
tempt to preserve and promote fertility is 
laudable and often rewarding. Endometri- 
osis is one of the few conditions in which 
"piecemeal" surgery in the pelvis is justi- 
fied. An infected endometrioma is excised, 
usually without drainage ; a bleeding area 
is usually removed ; when intestines ai*e ad- 
herent or kinked, they are freed and the 
implants excised or fulgurated ; when pelvic 
viscera are distorted, they are replaced and 
raw areas protected. If the patient's con- 
dition is satisfactory and if she has had se- 
vere dysmenorrhea, pre-sacral neurectomy 
could be included and will often give grati- 
fying relief. Prolapsed and adherent ovaries 
and tubes should be freed and suspended 



:;::u 



NORTH CAROLINA MEDICAL JOURNAL 



Aue-ust, ItiCO 



with minimal trauma. A uterus that is path- 
ologically fixed in retroversion might offer 
one of the few remaining justifications for 
the procedure of uterine suspension. 

Endometrioma of the bladder and rectum, 
usually the anterior wall, sometimes are so 
extensive that partial resection of the viscus 
is necessary for relief; and if the process is 
quite extensive, castration might be neces- 
sary. If in doubt, one is usually safe in being 
conservative, since castration can later be 
accomplished by x-ray. 

Culdoscopy carries a hazard in extensive 
pelvic endometriosis and is of value chiefly 
in the differential diagnosis of obscure pelvic 



complaints with little or no palpatory find- 
ings. 

Conclusion 

In a discussion dealing primarily with the 
acute complications possible in pelvic en- 
dometriosis, it is not necessary to outline the 
ideas regarding histogenesis nor to relate 
the most recent studies of the response to 
endocrine therapy. The background and 
current management of this condition make 
fascinating study. Such a study is definitely 
warranted in the effort to reduce the increas- 
ing incidence of this crippling lesion. 



Medical and Hospital Costs of the Aged 
A Current Appraisal 



Walter Polmer, Ph.D. 
Madison, Wisconsin 



The medical profession is now facing a 
problem which it has to a large extent cre- 
ated. The United States has a population 
of more than 175 million persons, of whom 
16 million are aged 65 years and over. The 
persons in this age group are increasing at 
about twice the rate of the over-all popu- 
lation. 

Wherever one turns in the literature on 
aging there echoes the theme crisply stated 
by Piersol and Bortz in the late 1930's : "The 
society which fosters research to save human 
life cannot escape responsibility for the life 
thus extended. It is for science not only to 
add the years to life- but more important to 
add life to the yeai-s." But will the added 
years of life be burdened by disease, illness, 
disability, and high medical costs? 

Persons aged 65 years and over are be- 
coming increasingly aware of the value of 
good medical care. Certainly they have rea- 
son to be thankful for this type of medical 
care. In the past, pain, disability, and seri- 
ous illness involved relatively little expense, 
because there was little that could be done 
for a sick person. Now pain and disability 
can often be avoided and death significantly 
postponed, but at the cost of more visits to 
the physician, more admissions to hospitals, 
more use of drugs and other treatments. All 
these medical expenses must be met either by 
the elderly patient, his family, the physician, 



the hospital, or society. In the light of de- 
creasing mortality among the middle-aged 
and the aged, the recent increases in the cost 
of medical care do not seem excessive. In 
fact, some authorities believe that we do not 
yet spend enough for health care. 

Rising Expenditures for Medical Care 

As part of their rising standard of living 
today, the American people are spending 
more money on medical care than ever be- 
fore. Part of the increase reflects popula- 
tion growth and rising prices ; even on a per 
capita basis and with prices held constant, 
medical spending has increased. For this 
large outlay, the American consumer today 
receives a greater quantity and variety of 
improved medical services. 

Studies by the Health Information Foun- 
dation indicate that in 1929 Americans spent 
$3 billion for medical care. Over the next 
four years, as economic activity contracted, 
annual expenditures dropped by about one- 
third, reaching just below $2 billion in 1933. 
Expenditures for medical care have in 
creased each year since then. In 1959 the 
public spent an estimated $22 billion, about 
7 times as high as in 1929. 

Gross expenditures for medical care since 
1929 reflect a rise in spending by consumers 
not only for the total, but also for each major 
component of the medical care index in both 



August, 1960 



MEDICAL COSTS OF THE AGED— POLMER 



331 



gross and per capita terms. Payments to 
the physician, largest of the components, in 
1929 through 1954 rose from $959 million 
in 1929 to over $2.5 million in 1957. Al- 
though impressive, this increase has been 
overshadowed by other components. The 
physician's share of the medical care dollar 
dropped from 32.6 to 24.5 cents. In contrast, 
spending for hospitals rose from $403 mil- 
lion in 1929 to $3,884 million in 1957. In 
like manner, expenditures for hospital and 
medical care insurance rose from $108 mil- 
lion in 1929 to $1,064 million in 1957. 

Part of the increase in spending for med- 
ical care followed the swelling income of the 
American people. Disposable personal in- 
come — that is, income after taxes — rose 
from $683 per capita in 1929 to $1,812 per 
capita in 1957. Medical expenditures con- 
stituted 3.5 per cent of disposable personal 
income in 1929 ; it then rose to 4.4 per cent 
in 1932. By 1957 spending for medical care 
amounted to 4.9 per cent of the disposable 
personal income. The American consumer, 
including the aged person, has been putting 
greater emphasis on medical care. Medical 
care is now becoming an important part of 
the American standard of living. 

Economists must consider the over-all pic- 
ture in analyzing a situation. Analysis, how- 
ever, does not prevent the economist from 
understanding that- while he may speak of 
billions of dollars or millions of people, it is 
still the individual aged person and his fam- 
ily that is most important. All analysis will 
concern large groups. The prime interest of 
the research still is the individual. 

A large segment of the older population 
does not receive active hospital or nursing 
care. According to available information, 
about 1.8 per cent of all older people are in 
the hospital a single day and occupy less 
than 20 per cent of the total number of pa- 
tient beds in short-term general hospitals. 
Yet, the recent report of the Commonwealth 
of Massachusetts stated : "Persons past 65 
years of age have the highest rates of chronic 
disease and disability of any age group. Al- 
most one in every two aged persons has a 
chronic disease or impairment. While they 
make up just 8% of the population, on any 
given day, they occupy 18 r /( of our general 
hospital beds, 22% of our long-term hospital 
beds and 80 to 90 '/< of the beds in nursing 
homes. In addition, it has been estimated 
that 16% of the aged were suffering from a 
form of disability lasting more than six 



months as opposed to only 3% of the work- 
ing age adults. Not only is their average 
length of stay longer in the hospital, nursing 
homes and other institutions, but aged use 
the services of a physician more often than 
do any age groups." 

The average cost of medical care for those 
65 years and over is higher than for the gen- 
eral population. The Health Information 
Foundation found in the early 1950's that 
persons 65 years of age and over averaged 
$102 per person in expenditures for private 
personal health services, or 57 per cent more 
than the $65 per person cost in general pop- 
ulation. 

The rise in the aged population has 
brought about many conferences, institutes, 
meetings, and statements of experts. It is 
the purpose here to present a background for 
viewing the expenditures for medical and 
hospital care of the aged based on current 
research. 

Medical Costs 

Let us be practical about this matter of 
medical costs. For some, any medical ex- 
penditure will be a problem ; for others, vir- 
tually no medical expenditure will be a prob- 
lem. It becomes important to remember that 
we are discussing only the purchase of the 
best type of medical care. This is the type 
of medical care that will answer the organic 
or psychological problem facing the aged. 
Apparently no sum is too great for most 
people to spend in order to preserve life. 
Medical care is not confined to stays in the 
hospital or visits to the physician. For the 
aged- medical care consists also of preventive 
and rehabilitative processes needed to main- 
tain the aged person in active life in the 
community. Although preventive medicine 
is of growing importance, the emphasis here 
will be on the hospital and physician charges. 
This is because of lack of research on the 
actual payments for the rehabilitative ele- 
ments of medical care. These elements, how- 
ever, are primordial in maintaining the aged 
person in the community and lowering fu- 
ture medical costs. 

The present health conditions of the na- 
tion are improving. Besides medical ad- 
vances, changes in housing, nutrition, edu- 
cation, and employment for the American 
people in the last half century cannot be 
overlooked. Although preventive medicine, 
rehabilitation, and recreation are important, 
they will not be emphasized — in order that 



332 



NORTH CAROLINA MEDICAL JOURNAL 



August, 19(10 



we can concentrate on more controversial 
research. 

"Disease" and "Disability" 
We have the unhappy habit of using the 
words "illness," "disease," and "disability" 
as if they were interchangable. The ma- 
jority of us have some type of disease. Some 
have bad eyes and wear glasses ; others have 
sinus conditions or asthma ; others have va- 
rying degrees of arthritis. All these are 
diseases. Each may be important to the in- 
dividual, but the key point is the extent of 
disability resulting. Too quickly it is pointed 
out that the morbidity of the aged is four 
times that of persons aged one to 14. The 
key question still is: Does the disease cause 
the individual disability and higher medical 
costs? If the individual has adjusted him- 
self to the disability, as have those of us 
who wear glasses, does the condition really 
matter? A chronic disease does not neces- 
sarily constitute a chronic illness problem. 

Large Bills for Medical Care 
Hardly anyone likes to pay a doctor's or 
hospital bill ; the majority of us never do 
pay a high bill. In a recent survey made by 
the magazine Medical Economics to deter- 
mine the highest bills charged by physicians, 
the median highest charge for 171 special- 
ists was $650. Most bills for medical care 
in any one year are less than $300. The 
majority of the people do have more than 
$300. A recent survey by the New Jersey 
Blue Cross shows what this would mean. 
The New Jersey Blue Cross has a 120-day 
basic hospital care plan. Their study indi- 
cated that out of every 100 claims filed under 
this plan, 90 were paid in full by the plan. 
Six were paid partially by the plan and only 
four went into the area of extended, high- 
cost medical care. Therefore, probably less 
than 10 per cent of those receiving hospital 
care have high medical bills. The National 
Health Service has shown that approximate- 
ly 90 per cent of the aged who enter a short- 
term general hospital are discharged in less 
than 30 days. These persons, however, fear 
that they will be one of those 10 who remain 
more than 30 days. They fear that they will 
be among those 4 whose bills will extend be- 
yond the 120 days of the basic Blue Cross 
policy. This is a situation which we must 
come to grips with. 

Does anyone really want to cut the high 
expenditures for medical care? Would the 
aged person prefer to do without medical 



and hospital care rather than pay for these 
services? Would the physician prefer to give 
his patient less than the best possible med- 
ical management? Would the hospitals rather 
not have the radioisotope department take 
care of patients? I think the answer is that 
everyone wants the best possible type of 
medical care and is willing to pay for it, if he 
can. 

Medical expenditures have been rising 
since 1945. We do not have the statistics 
for the entire aged population, but we do 
have them for the population as a whole. 
We may have paid too much attention to 
the relative increase in medical costs and too 
little to what medical care would have been, 
had these expenditures not been made. At 
the present time the entire population pays 
about $2,500,000,000 for physician services 
as contrasted with about $1,500,000,000 in 
1949. When it is considered that in the same 
period of time the national income rose from 
$400 billion to approximately $440 billion 
this does not seem a very great rise. The 
same should be said for hospital costs. We 
have doubled hospital expenditures since 
1949— from roughly $2 billion to $4 billion. 
This may not be too great a price to pay 
for an increase of over 150,000 new hospital 
beds. A hospital bed must be paid for wheth- 
er it is being used or not. The hospital must 
be ready to take care of the patient in emer- 
gencies, and it costs roughly 70 per cent of 
the cost of an occupied bed to maintain an 
unoccupied bed. 

Paying Medical Care Costs 

These figures are averages, but are the 
aged able to pay for these services? One 
report stated that 60 per cent of the aged 
have an annual income of less than $1,000. 
The aged are not isolated. The majority are 
living either with their spouses or with a 
family. For example, there is the aged wid- 
ow who would normally move in with the 
daughter's family, if at all possible. This 
widow has a very small income, but she prob- 
ably pays no rent and receives some type of 
income from the daughter's husband whether 
he likes it or not. In a medical crisis the 
family will, according to recent research, 
come together to aid the mother. The mat- 
ter of income is not the entire story of the 
aged's resources to pay for acute illness. 

By the time the aged person has left the 
labor market or entered widowhood, there 
has been an accumulation of assets and in- 



August, 1960 



MEDICAL COSTS OF THE AGED— POLMER 



333 



come. The direct income from labor market 
activity may not be too great- but the in- 
come based on assets may be of great value 
in a "crisis." As an example, in 1959, an- 
nuities based on past income paid to those 
over age 65 came to nearly $450 million a 
year. Whether the aged person will consider 
this income or annuities is a question which 
research can throw little light on. 

According to available research, the ma- 
jority of aged persons pay their entire 
charge to the hospital and the physician. 

Voluntary Health Insurance 
We have been discussing this entire ques- 
tion of medical expenditures as if voluntary 
health insurance did not exist. Of course it 
exists and is utilized by an increasing num- 
ber of aged persons. In 1951 it was esti- 
mated that about 1,800,000 persons aged 65 
and over, or 15 per cent, were covered by 
voluntary health insurance. By 1958, 43 per 
cent or 6,600,000 aged persons were being 
covered by voluntary health insurance. Last 
year the expansion of Blue Cross-Blue Shield 
and other health insurance plans have prob- 
ably increased this number much more. 

In the past, we have stated that voluntary 
health insurance among the aged increases 
at a rate of approximately 3 per cent a year. 
If we use this conservative figure, at least 
47 per cent of the total aged have voluntary 
health insurance. Yet there are many aged 
persons who for religious and other reasons 
do not want voluntary health insurance or 
who can receive the same benefits without 
paying for it. Research provides some idea 
of the categories involved. We do not have, 
however, exact figures as to the number of 
veterans who look upon the local Veterans 
Administration hospital as "their voluntary 
health insurance" benefit. The Health In- 
surance Association of America estimated 
that in 1957 between 3 to 5 million persons 
could be included in the group that does 
want or need voluntary health insurance. If 
you take the mean of 4 million persons, an 
increasing coverage has been already pro- 
vided for the aged by voluntary health in- 
surance. 

Voluntary health insurance seems to be 
doing a good job for the majority of the 
acutely ill aged people who have it. A re- 
cent survey published by the U. S. Depart- 
ment of Health, Education and Welfare 
stated that only 14 per cent of the couples 
and 9 per cent of the individuals under Old 
Age Survivors Insurance received any bene- 



fits from their voluntary health insurance 
to help pay for medical care. This, of course, 
is true. In order to determine what was be- 
ing spent for all medical care, the OASI 
attempted to survey all expenditures for 
medical care such as osteopathic services- 
physicians' services, faith-healing, nursing 
home care, dentistry, hospital care, ethical 
and proprietary drugs. The result was ex- 
actly what everybody expected. The major- 
ity of aged people do not go into the hos- 
pital and do not receive any aid from vol- 
untary health insurance. It is one thing to 
say that expenditures for proprietary drugs 
is a medical care cost. I do not think that 
anyone will argue with the fact that for 
many this is true. Should voluntary health 
insurance pay for the purchases of aspirin, 
vitamins and antibiotics? The decision may 
well be that they should. If so, the cost of 
voluntary health insurance may go much 
higher than it has in the past. According to 
the statistics of the OASI survey, approxi- 
mately 20 per cent of the OASI couples used 
the hospital within a year. This would 
mean that while 43 per cent of the aged had 
voluntary health insurance, it may be that 
close to 65 per cent of all of those who were 
hospitalized received aid from voluntary 
health insurance. 

The quality of coverage provided by vol- 
untary health insurance is quite important. 
There has been no study at the present time 
that can tell us the amount of the total hos- 
pital and physician charge to the aged paid 
for by voluntary health insurance. Part of 
the research problem has been that for cer- 
tain diseases voluntary health insurance does 
not provide aid for needs such as cosmetic 
surgery or psychotherapy. Yet research in 
Michigan Blue Cross on the aged seems to 
show that approximately 90 per cent of all 
hospital bills of the aged were paid for by 
voluntary health insurance. Whether it 
should be 100 per cent is a question which 
I think should take additional study. 

Statements to the effect that voluntary 
health insurance cannot provide coverage for 
the aged come from persons who have not 
tried to provide it. As an example, in 1938 
the Federal Government called a conference 
on voluntary health insurance. The report 
found that because of the low income of the 
people of the United States, the voluntary 
health insurance movement must fail. "The 
conclusion is inescapable that considerable 
proportions of the nation's families are too 



.334 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



poor to afford the cost of adequate medical 
care from their own resources. In the face 
of needs which are vital and urgent for, at 
least, 100 million persons in the United 
States, the Technical Committee on Medical 
Care cannot find the answer to the nation's 
problem in voluntary insurance methods." 

"Fortunately, the voluntary health insur- 
ance movement went ahead and provided 
coverage. They did not stop to listen to the 
experts who told them it could not be done. 
By now we have coverage for approximately 
71 per cent of the entire population. It is 
estimated that- possibly by 1975, a large ma- 
jority of the aged who need and want vol- 
untary health insurance will have it. By 
1958, for example, the number of Blue Shield 
plans that will enroll persons over age 65 
had risen from 8 to more than 30 plans, 
with many more planning to provide such 
coverage within this coming year. 

Catastrophic Illness 

The problem, however, facing many of the 
aged is not only one of actual medical ex- 
penditure. It is the fear of a high medical 
expenditure in the future. Almost everyone 
knows someone who has had to pay $1,000 
or $2,000 for medical care. In essence, we 
are discussing the chronically ill of any age. 
It is expensive to be ill. Chronic illness 
drains the resources of the individual and 
the family in time. The 85 year old person 
with chronic arthritis and the Mongoloid 
child are both chronically ill. Their needs 
must be provided for. Research seems to 
suggest a way by which this can be done. 
It has been only 10 years since the concept 
of "major medical" or prolonged illness con- 
tract appeared on the American scene. Ten 
years ago anyone who said that there could 
be a major medical plan for over $5,000 was 
laughed at. Today they are selling major 
medical plans for $10 to $20,000. In Massa- 
chusetts, the Massachusetts Blue Cross-Blue 
Shield has an experimental program to find 
out about what it would take to sell a $5,000 
"Master Medical" or "Prolonged Illness" 
program to the aged. One firm is already 
providing $15,000 worth of major medical 
benefits to their retirees. With the inflation- 
ary trend, $5 to $15,000 may be too small in 
the future. Perhaps it may be necessary to 
go to $40 or $50,000 in order to make sure 
that the chronically ill costs of that small 



group of the aged are adequately taken care 
of. If a reasonable deductible clause and a 
reasonable coinsurance feature are included, 
it may be possible to sell these policies. At 
the same time, the basic contract coverage 
must be extended. 

Summary 

In facing the problem of those in the older 
age groups who are in need of medical, eco- 
nomic or social aid, one can enumerate as- 
pects of that problem, devise solutions, and 
eventually try to coordinate the different 
solutions into a program. One can also take 
one of the numerous solutions in the litera- 
ture and accept it as the answer. I prefer 
the former pragmatic approach. There are 
certain problems of medical care expendi- 
tures among the aged. They must be met. 
There is not one single problem, but a whole 
series. Perhaps the solutions presented by 
an English doctor is one for us to contem- 
plate. "A completely unified and regimented 
service on the behalf of the aged would be 
akin to the nature of the problem but would 
defeat any attempt to distribute responsi- 
bility for them among all classes of the com- 
munity and might lessen public concern. 
Certainly, it may be unwise to allow the idea 
to gain substance that care of the aged will 
be taken over completely by the diffuse father 
figure of the state." We are all involved, for 
health like happiness is an objective always 
to be sought even if it can never be fully 
obtained. 

In the recent book, The Image of America, 
R. L. Bruckberger, a French Dominican 
Father, pointed out that our country has 
demonstrated a genius for solving social 
problems that have baffled mankind for gen- 
erations. There is very little marriage to 
dogma and ideology, but a great national 
confidence that we can find solutions to our 
difficulties. This has resulted in the willing- 
ness to experiment, to explore, to be flexible 
in our approach to social and economic prob- 
lems and developments. The question of 
paying for medical care by the aged will be 
met in the same way. 



(Note: An extensive bibliography has been prepared for this 
article. It may be obtained from the editor). 



August, 1960 



ADVERTISEMENTS 



XXV 




One way or another people will seek 
out new ways to cope with old prob- 
lems. Yet progress must be wisely 
guided. One doctor says: 'The desire 
of the public to have prepayment 
medical protection is so urgent 
that it will buy this protection from 
whatever plan seems most enticing. 
Whether you like it or not, prepay- 
ment medical care is here to stay. Let 
us support the system which is vol- 
untary and over which we have ade- 
quate control." BLUE SHIELD 



HOSPITAL SAVING ASSOCIATION 

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Concerning Your Health and Your Income 

A special report to members of the Medical Society of 

the State of North Carolina 

on the progress of the Society's 

Special Group Accident and Health Plan 

in effect since 1940 

PROUDLY WE REPORT 1959 

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY. 

During the year we introduced a NEW and challenging form of disability protec- 
tion. There has been overwhelming response on the part of the membership. 

Participation in this Group Plan continues to grow at a fantastic rate. 

1960 

is our 20th year of service to the Society. It is our aim to continue to lead the field in pro- 
viding Society members with disability protection and claim services as modern as tomor- 
row. 

SPECIAL FEATURES ARE: 

1. Up to a possible 7 years for each sickness (no confinement required). 

2. Pays up to Lifetime for accident. 

3. New Maximum limit of $650.00 per month income while disabled. 

All new applicants, and those now insured, who are under age 55, and in good 
health, are eligible to apply for the new and extensive protection against sickness and ac- 
cident. 

OPTIONAL HOSPITAL COVERAGE: Members under age 60 in good health may apply for 
$20.00 daily hospital benefit — Premium $20.00 semi-annually. 

Write, or call us collect (Durham 2-5497) for assistance or information. 

BENEFITS AND RATES AVAILABLE UNDER NEW PLAN 

COST UNTIL AGE 35 COST FOR AGES 35 TO 'i 



Accidental Death 'Dismemberment 



Coverage Loss of Sight, Speech Accident and Annual Semi-Annual Annual Semi-Annual 

or Hearing Sickness Benefits Premium Premium Premium Premium 

5,000 5,000 to 10,000 50.00 Weekly $ 78.00 $ 39.50 $104.00 $ 52.50 

5,000 7,500 to 15,000 75.00 Weekly 114.00 57.50 152.00 76.50 

5,000 10,000 to 20,000 100.00 Weekly 150.00 75.50 200.00 100.50 

5,000 12,500 to 25,000 125.00 Weekly 186.00 93.50 248.00 124.50 

5,000 15,000 to 30,000 150.00 Weekly 222.00 111.50 296.00 148.50 

'Amount payable depends upon the nature of the loss as set forth in the policy. 

Administered by 
J. L. CRUMPTON, State Mgr. 
Professional Group Disability Division 
Box 147, Durham, N. C. 

J. Slade Crumpton, Field Representative 
UNDERWRITTEN BY THE COMMERCIAL INSURANCE COMPANY OF NEWARK, N. J. 

Originator and pioneer in professional group disability plans. 






August, 1960 



335 



Medical Problems Facing Congress 



Sam J. Ervin, Jr.* 
Washington, D. C. 



It is a great privilege to be here today 
and to talk to you who practice the healing 
art. Any member of a legislative body is 
necessarily concerned with public health, 
because the government has been concerned 
with this problem for generations. 

We have many problems in Washington, 
but I'm inclined to think that some of the 
solutions offered are worse than the prob- 
lems. We have a very loquacious member 
of the Senate in the person of Hubert 
Humphrey. Some newspaper man writing 
about him a few days ago said he was the 
only man in public life who had had more 
solutions than there were problems. Inci- 
dentally, I think maybe the medical pro- 
fession has a few unsolved problems of its 
own. 

The Government's Role in the 
Field of Health 

I want to talk this morning, as briefly 
as any member of the United States Sen- 
ate can talk, about the place of the federal 
government in the field of health. I think 
the federal government has a real place in 
this field, and one that has probably become 
more important as a result of existing con- 
ditions. 

The most astounding advances have been 
made in medicine during the past quarter 
century than in any other field of life. In 
the old days a doctor could carry the tools 
of his profession in a small bag, but with 
the advancement of medical science, the 
cost of treatment, when considered on a 
nationwide basis, has become enormous. 

In the days before the astronomical rise 
of the national budget, when Congress 
thought that perhaps the taxpayers knew 
better how to spend their income than Con- 
gress did, and when income taxes were 
either nonexistent or low, many people 
were able to make great contributions to 
causes and institutions such as hospitals 
and medical schools. But as time passed 
and the national budget rose from $3 bil- 
lion in 1930 to $79.8 billion in 1960, the 

Reporter's Transcript of an address delivered before the 
First General Session of the Medical Society of the State of 
North Carolina, Raleiffh. May 9, 1060. 
"Senior Senator from North Carolina. 



federal government has been confiscating 
large parts of the individual personal in- 
come of the American people by way of the 
federal income tax. As a result, it has be- 
come virtually impossible for people to 
amass large fortunes as they did in times 
gone by, and consequently individual gifts 
to medical school and hospitals have great- 
ly diminished. This factor has added to the 
difficulties confronting the nation at this 
time. 

From the time that the Marine Hospital 
was established in 1797 down to this day, 
the federal government has had a real 
place in the field of public health. Today, 
as you know, it makes grants to state and 
local health authorities for general pur- 
poses and sometimes for specific ones. 

Then the federal government I think, has 
a right, under the Hill-Burton Act, to as- 
sist the states and communities in the erec- 
tion of hospitals. This program has been 
extended of late to include nursing homes. 

The federal government, I believe, has a 
real place in the field of medical research 
and is doing a fine job in the National In- 
stitutes of Health in Bethesda, Maryland. 

As a result of the inability of the Amer- 
ican people to make large gifts to medical 
schools, the federal government can help 
(1) through cooperative arrangements with 
the faculties of medical schools in the re- 
search field, and (2) by providing fellow- 
ships and traineeships to medical students. 
Also, I think the government has done a 
fine thing in establishing the great insti- 
tution which we now have in Cincinnati 
for study in that very essential field of 
public health. 

Objections to Pending Bills 

I know you are interested in some of the 
medical problems now confronting Con- 
gress, and particularly in the Forand bill. 
A number of other proposals are pending. 

If I controlled the situation, I would 
postpone any consideration of these bills 
until next January, simply because most of 
them, when analyzed, appear to be designed 
to promote or protect the political health 
of some members of Congress, rather than 



336 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



the health of the people in whose behalf 
they are supposed to be offered. 

Frankly, I believe that a serious problem 
exists in this field — one which merits the 
consideration of the medical profession, the 
Congress, the states, and local communi- 
ties. But I do not think that any of the pro- 
posals made thus far are the correct solu- 
tions. 

With no wish to be partisan, I refer first 
to the Administration Program — a hodge- 
podge proposal, thrown together hurriedly 
merely as what you would call a counter- 
irritant to the other political bills on this 
subject. 

Contrary to Social Security concept 

These proposals have several fundamen- 
tal objections. In the first place, being 
geared to Social Security rules, they in- 
volve a serious question as to whether or 
not we should depart from the original 
concept which underlies the system. 

This idea was that, while the system was 
compulsory in nature, when a person be- 
came eligible for Social Security benefits 
he was to receive them as a free man ; that 
they belonged to him, and that he was to 
have the privilege of doing what he wished 
with them. 

A bill which undertakes to place the cost 
of medical and hospital care under the So- 
cial Security system is an absolute depar- 
ture from that concept, because it provides 
that the contracts are to be made by the 
Secretary of the Department of Health, 
Education and Welfare, except when he 
might delegate that authority to some one 
of the insurance companies. Furthermore, 
he not only makes these contracts but han- 
dles the monies for all recipients of Social 
Security benefits. So one serious problem 
confronting the American people and the 
Congress is whether or not they are going 
to depart entirely from the original Social 
Security concept that a man should be free 
to handle his own funds. 

These bills say, of course, that a man can 
select his own surgeon and his own hos- 
pital. This is not exactly true, because he 
can select only a surgeon or a hospital hav- 
ing a contract with the Secretary of Health, 
Education and Welfare, or with the dele- 
gated agent of the Secretary. Furthermore, 
he is denied the right to make any con- 
tract with respect to his treatment, because 



he cannot contract to pay the hospital or 
the surgeon a cent more money than that 
which is to be paid by the government un- 
der the contract with the Secretary or his 
agents. 

Fail to help the neediest 

One objection, as I see it, to these bills 
in their present form is that, except the 
Administration bill and the McNamara bill, 
none of them provides any assistance what- 
ever for the people who need it the most. 
As a general rule most of the people on 
Social Security can meet their own medical 
expenses. 

At the risk of being charged with the 
same offense as was a storekeeper that I 
will now tell you about, I want to present a 
few statistics. A certain mountaineer who 
had been buying groceries on credit at the 
neighborhood store received a bill which 
was considerably more than he thought it 
ought to be. When he complained, the gro- 
cer got out the account book, laid it on the 
counter, and said: "Here are the figures; 
look at them yourself. Figures don't lie." 

The mountaineer said, "No, figures don't 
lie, but liars sure do figure." 

At the risk of falling into that category, 
I wish to quote some figures that I think 
are germane to this matter. There are ap- 
proximately 16 million people in the United 
States of the age of 64 and up, who are 
now called aged people in legislative par- 
lance in Washington. Of these approxi- 
mately 2,250,000 receive Old Age Assist- 
ance. They are, in a sense, financially desti- 
tute. They are the people who normally 
need medical, surgical or hospital treat- 
ment the worst, but are the least able to 
provide it for themselves. 

Such measures as the Forand bill make 
no provision whatever for this group of 
people. Benefits are confined to those who 
are receiving Social Security, and the aver- 
age person on Social Security, even though 
he be 65 or older, can pay his own medical 
and hospital bills. The records show that 
these bills average approximately $125 in 
the course of a year, and most Social Se- 
curity beneficiaries can handle that. 

Now, the people who receive Old Age 
Assistance do so because they are destitute. 
If there is any group of people that are in 
need, not only of the necessities of life but 
also medical care, it is they. It is true they 
receive some medical benefits through the 



August, I960 



MEDICAL PROBLEMS FACING CONGRESS— ERVIN 



337 



Welfare Service, and I think that those 
benefits should be expanded. 

Another group of persons that I think 
the medical profession, the Congress, and 
the state legislatures and state health 
authorities must consider are elderly peo- 
ple who have just enough property to be 
ineligible for Old Age Assistance but who 
would be destroyed financially by chronic, 
protracted illnesses. 

The average person under the Social Se- 
curity system does not come within this 
group, which constitutes only a minority of 
our elderly citizens. But there must be some 
system whereby discretionary power would 
be given the public health authorities to as- 
sist these persons, and there should be pro- 
vision through the Welfare Service to help 
those in a more expanded way on Old Age 
Assistance. 

Fundamentally, the trouble with the cur- 
rent proposals is that they do not help the 
people who are most in need of aid. Politi- 
cians are funny when they start doing 
something: they want to be like the rain 
which falls on the just and the unjust alike. 
In this case, they want the benefits to fall 
on the needy and those that are not needy. 
They treat them exactly the same. That is 
precisely what these bills do. 

For that reason, since they exclude peo- 
ple on Old Age Assistance and make no 
provision for those with limited means who 
suffer for long- periods of time, are chron- 
ically ill, and ought to have some discre- 
tionary relief rather than relief which ap- 
plies to all alike, I am opposed to such leg- 
islation. 

Limited benefits 

The bills are inadequate for another rea- 
son. They are limited. Under these bills — 
the Forand bill, for example — a man can 
get two months of hospital treatment. That 
wouldn't help anyone who was sick for 
months and months or a person who is 
chronically ill for several years. It is true 
he can go to the hospital for two months, 
but then he would have to get along as best 
he could, and it would be 10 more months 
before he would be eligible to go back to 
the hospital. Furthermore, provision is 
made for surgical but not medical treat- 
ment. The tragedy is that every day I re- 
ceive letters from old people urging that 
certain bills be passed, when most of the 
writers wouldn't receive a single penny 



under any of them, with the possible ex- 
ception of some phases of the Administra- 
tion bill, which, as I say, is a hodge-podge 
hurriedly thrown together as a counter- 
irritant for the other bills. It is a tragedy 
that the old people of this country have 
been deceived about the contents of these 
bills. They think all their medical expen- 
ses, all their hospital expenses, and all their 
surgical expenses would be covered, where- 
as the neediest people wouldn't receive any 
benefits whatsoever. 

Threat to doctor-patient relations 

To me one of the greatest relationships 
that exists is that of patient and physician. 
These bills would certainly interfere with 
that relationship because, while they pro- 
fess that the man is free to select his sur- 
geons or free to select his hospital, he has 
to select a hospital or a surgeon who is 
under contract with the Secretary of 
Health, Education and Welfare or his 
agent. Furthermore, he cannot contract, 
however much he may need it, if he goes 
into a hospital under one of these bills, 
above the contracted for price of the hos- 
pital. Under the contract with the Secre- 
tary, he cannot make any contract to pay 
any more, even though he may need more 
than he is allowed. 

One thing is certain : when the federal 
government begins to pay medical bills di- 
rectly, the next step is standardization, and 
you are going to have standardization un- 
der the auspices of the federal government 
if one of these bills is passed. The Secre- 
tary of Health, Education and Welfare is 
to write regulations to carry out the pro- 
visions, and I doubt whether any of you 
physicians, except those engaged in public 
health work, really understand what this 
means. 

The last time I was engaged in the active 
practice of law, I subscribed to the publi- 
cation known as the Federal Register, 
which contains all tederal regulations. As 
the issues came out, I had them bound and 
placed in my office for a period of 18 
months. The regulations and changes in 
regulations for only 18 months occupied a 
space of about 28 inches, by actual meas- 
urement. 

You are going to have these regulations, 
and you are going to have things stand- 
ardized, and you are going to destroy one 
of the greatest human relationships known 



338 



NORTH CAROLINA MEDICAL JOURNAL 



August, 19G0 



to man, the relationship of physician and 
patient; and for that reason I look upon 
these bills with grave misgivings. 

To repeat, I do think there is a problem 
here, but it lies in the case of persons on 
Old Age Assistance and those who have 
just enough to be excluded from that un- 
fortunate group, but not enough to bear the 
cost of a loii • illness. That is a problem 
that the medic?.] profession, the Congress, 
the state legislatures, and public health 
authorities must be concerned with. A solu- 
tion must be found, but I do not think that 
it lies in the adoption of a system under 
which the federal government assumes the 
responsibility for the medical needs of 
virtually all of our elderly citizens. The peo- 
ple who should be helped are those who 
need help, and the rest should be allowed 
to act as free men and free women, as the 
Social Security system in its original con- 
cept contemplated. 

I return to what I said at the beginning 
of this talk: that the kindest thing that 
can be done with this serious problem of 
the chronically ill is to postpone further 
discussion until the atmosphere is free 
from the political bargaining which is now 
going on in Washington in reference to the 
Presidential election of 1960. 

Voluntary Health Insurance 
In my opinion, the problem of the chron- 
ically ill cannot be met entirely by the vol- 
untary insurance program. That is a mar- 
velous program, however, and I want to call 
your attention to the astounding increase 
in the number of persons protected by 
it. The figures for 1957 indicate that 
121 million people in the United States, or 
72 per cent of the total population, had 
hospitalization insurance of some kind, as 
contrasted with 37 per cent who had hos- 
pital insurance 10 years before. 

In 1957, 109 million persons in the United 
States (55 per cent of the total population) 
had voluntai-y insurance policies which took 
care of the hospital and surgical costs to 



some extent. In 1957, 57 per cent had 
health policies which provided for the pay- 
ment of medical treatment, as distin- 
guished from surgical treatment, in addi- 
tion to hospitalization. In view of these 
figures, we should refrain from adopting 
any system which would tend to destroy 
the willingness of the American people to 
procure hospital, surgical, and medical in- 
surance on their own volition. 

The amounts paid under these plans is 
astounding. Also in 1957, 57 per cent of all 
the cost of hospital services in the United 
States and 31 per cent of all bills for sur- 
gical and medical expenses was paid by 
these voluntary plans. I hope that the 
services rendered by such organizations as 
Blue Cross and Blue Shield, which are do- 
ing a fine job in North Carolina, continue 
to expand, and that they will be even more 
widely accepted. 

Some of the companies today are at- 
tempting to devise policies that cover the 
needs of the aged. One of the main argu- 
ments used for the Forand bill is the great 
spread of difference between the nonprofit 
organizations, which return about 97 per 
cent of their premiums in services to their 
policyholders, and the private insurance 
companies, which do not do anywhere near 
that well. 

Conclusion 

I believe in the expansion of nonprofit 
organizations. But when voluntary insur- 
ance is improved and extended, the prob- 
lem that will still confront the medical pro- 
fession, Congress, and the states is that of 
people receiving Old Age Assistance, and 
of those suffering long illnesses who are 
barely ineligible for Old Age Assistance. 
That is the problem that should concern 
you as well as the Congress and the state 
legislature. 

Whatever we do, we must see to it that 
the personal relationship of physician and 
patient is preserved. 



The doctor's wife is truly the unsung hero of Medicine, because the 
extra hours of faithful service to patients and the hours spent attending 
medical meetings and studying the medical literature must be subtracted 
from the time the doctor would otherwise spend with his family. It has 
been said that the wife has the doctor when no one else wants him. — 
Rouse, M.O., South. M.J. 53:1 (Jan) 1960. 



August, 1960 



339 



Leptospirosis 

Report of a Case 

William A. Leonard, Jr., M.D. 

Greensboro 



For the past decade veterinarians have 
called attention to the occurrence of disease 
due to Leptospira in animal life in temper- 
ate climates. The disease in man has re- 
ceived some recent notice, but is probably 
more widespread than is generally known. 
In North Carolina it received wide recog- 
nition in 1942-1944, when it was deter- 
mined that so-called "Fort Bragg Fever" 
was due to Lept. autumnalis a) . Sporadic 
cases have been reported since 12 ', but the 
following is believed to be the first case re- 
ported from Guilford County. 

It has been demonstrated in this state 
and elsewhere that a wide variety of do- 
mestic and wild animals harbor the organ- 
ism (3) . The infection apparently presents 
a chronic problem in animals, with the ex- 
cretion of Leptospirae in the urine for pro- 
longed periods. Contrary to an earlier con- 
cept, apparently any animal may harbor 
any one of a variety of recognized serotypes 
of the organism which are present in the 
United States. In other words, there is no 
apparent animal or syndrome specificity. 

Weil's disease, a fulminating form char- 
acterized by fever, jaundice, renal damage 
and hemorrhage, was originally presented 
as the classic form of the disease in man. 
In more recent years it has become obvious 
that the more common clinical syndrome is 
presented by a mild type of infection not 
unlike grippe, influenza, nonparalytic polio, 
or aseptic meningitis. Again, as in animals, 
any one of the leptospiral serotypes may 
result in a similar clinical picture. This 
similarity to other common and benign ill- 
nesses has undoubtedly been the main de- 
terrent to its recognition. 

Case Report 

A 39 year old white male carpenter was 
well until two days before admission, when 
he noted the sudden and progressive de- 
velopment of profound fatigue, followed 
shortly by frank chilling, generalized mus- 
cular aching, a moderate generalized head- 
ache, and a fever of 104 F. The past his- 
tory was not contributory. 



Physical examination revealed an acute- 
ly ill, toxic individual in obvious discom- 
fort. The conjuctivae were suffused. There 
were fine crepitant rales at the base of the 
right lung posteriorly and laterally. The 
heart was not remarkable exceot for an 
apical rate of 120. The abdomen was slight- 
ly distended but non-tender. The liver and 
spleen were not palpable, and no hepatic 
tenderness was demonstrated on percus- 
sion. The pharynx was minimally injected. 
No significant adenopathy was noted. The 
remainder of the examination was entirely 
within the limits of normal. 

Laboratory findings: A urinalysis was 
negative. The blood count showed 8,500 
white cells, with 86 polymorphonuclears, 1 
eosinophil, 1 monocyte, and 12 lympho- 
cytes. A serologic test for syphilis was neg- 
ative. An electrocardiogram was within the 
limits of normal except for a sinus tachy- 
cardia. Roentgenograms of the chest showed 
prominent pulmonary markings at the 
right median base. 

The initial clinical impression was that 
of primary atypical pneumonia of unknown 
etiology. Because of the patient's toxic 
state, however, he was started on thera- 
peutic doses of chloramphenicol. Because of 
doubt concerning the diagnosis, blood was 
drawn at the time of admission for possible 
agglutination determinations later. A blood 
culture was not obtained. 

Since antibiotic therapy had obviously 
brought about little improvement within 48 
hours, it was discontinued. (Antibiotics 
have only questionable value in leptospiro- 
sis) (4) . At this time, the fine crepitant rales 
were continuously noted at the right base, 
and a few rales were present in the left 
base posteriorly. The patient continued to 
be acutely ill, and symptomatic treatment 
was used to control the muscular aching. 
The febrile course is noted on the accom- 
panying chart (fig. 1). At this point, be- 
cause of the continued presence of marked 
conjunctival suffusion, the possibility of 
leptospirosis was considered. 



:to 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



105° 




\ 


1 










1 
1 


104 






103 




\ 


b 












102 






ff 


\ 


A 


r 






101 




1 


r 


\/ 


\ 


J 


\ 




100 








V 






V\ 




98 6 














v\ 




Day of 


3 


4 


5 


6 


7 


8 


9 


10 


illne ss 

















1 



Fig. 1. Clinical course. 

The fever and symptoms gradually di- 
minished until the sixth day of illness, when 
the patient felt reasonably well. On this 
evening- he was intermittently confused and 
disoriented. He awakened on the seventh 
day with a moderately severe headache, and 
nuchal rigidity was observed. A lumbar 
puncture was done, with an initial pressure 
of 230 mm. of water and a final pressure 
of 130 after the gradual removal of 10 cc. 
of a hazy fluid. The specimen contained 300 
cells per cubic millimeter, predominently 
lymphocytes. The protein was 86 mg. per 
100 ml. and the sugar 76 mg. per 100 ml. 
Culture was sterile on routine media. 
Fletcher's media was not available. The 
onset of the meningitis on the seventh day 
of illness and the characteristic spinal fluid 
changes'"" appeared to confirm the clinical 
impression of leptospirosis. 

As will be noted on the accompanying 
clinical chart, the patient had some eleva- 
tion of temperature following the onset of 
headache and stiff neck. The removal of 
spinal fluid promptly relieved the headache, 
which did not recur, and on the following 
day the patient felt well. Several days after 
discharge from the hospital he complained 
of visual blurring and was referred for 
ophthalmologic consultation with the pre- 
sumptive diagnosis of leptospiral iridocy- 
clitis. The consultant agreed and success- 
fully treated the patient with topical ster- 
oid therapy. The subsequent course has 
been uneventful. 

The pattern of antibody titer is shown in 
figure 2. 

Comment 

When the diagnosis was initially sus- 
pected, the patient and his family were 



questioned in detail concerning possible 
modes of exposure to the leptospiral organ- 
ism. His occupation as a carpenter was not 
considered hazardous. He had not been 
swimming or wading in pools or streams 
that might have been contaminated. Four 
hunting dogs were kept penned on his pro- 
perty, but he admitted little or no contact 
with them. The State Board of Health in- 
vestigated his home situation and initially 
determined that he had recently helped re- 
model an old house which was apparently 
infested with rats. The dogs were bled and 
all found to be positive to Lept. canicola. 
Since surveys had shown a percentage of 
healthy dogs to be chronic renal shedders 1 '" 
and since Lept. canicola was the serotype 
apparently responsible for the patient's ill- 
ness, it seemed reasonable to assume that 
the dogs were the source of the infection. 

Although the patient was exceedingly un- 
comfortable, the disease had a relatively 
brief and benign course. The iridocyclitis 
represented the sole residual defect, and 
this condition cleared with proper therapy. 
The complication has been previously re- 
ported"'". The suffusion of the conjunctiva, 
which was present in 85 per cent of Ed- 
ward's cases' 71 , actually presented the first 
clue to the proper clinical diagnosis. 

The biphasic course of the disease is well 
demonstrated by this case. It will be noted 
that although the patient was clinically im- 
proved on the sixth day of his illness, he 
became somewhat confused and on the sub- 
sequent day showed obvious physical signs 
of meningitis. Whether this manifestation 



L. autumnalis 


neg. 


4 + 


14- 


L. australis A 


- 


4 + 


1 + 

1 + 


L. ballum 




4 + 


L. bataviae 




3+ j 


- 


L. canicola 


- 


4 + 


4+ 


L. hebdomalis 


- 


3 + 


- 


L. hyos 


- 


- 


- 


L. icterohem 


- 


3+ 


1+ 


' L. pomona 


- 


3 + 


14- 


L. pyrogenes 


- 


2 + 


- 


L. sejroe 


- 


3* 


~I+ ~~ 


L. grippotyph 


- 


3+ 


Day from onset 
of illness 


7th. 


14th. 


26th. 



Fig. 2. Serial agglutination determinations. 



August, 1960 



LEPTOSPIROSIS— LEONARD 



341 



might be more properly referred to as men- 
ingoencephalitis is not clear at this time. 

The explanation for the biphasic pattern 
has not been clarified. There is apparent 
general agreement that the first-stage man- 
ifestations are directly related to leptospi- 
remia. A positive blood culture is said to be 
possible only during this phase. The role of 
hypersensitivity in the pathogenesis of the 
second phase has been mentioned by sev- 
eral authors. Middleton' 71 proposed a hy- 
persensitivity reaction to account for the 
neurologic lesions, and Davidson 18 ' con- 
sidered "after-fever" to be an allergic phe- 
nomenon. Edwards' 6el also expressed the 
opinion that the second stage appeared to 
be the consequence of the body's immuno- 
logic responses. 

In this temperate climate leptospiral in- 
fections probably have seasonal variation, 
in contrast to the lack of variation in trop- 
ical areas where animal and human activ- 
ities, high humidity, and temperatures are 
more constant. Humbert' 2 ' considered the 
wet spring months, with their high waters 
and floods, a possible high-incidence period. 

Headache is present in all and conjunc- 
tival suffusion in 85 per cent of the cases. 
A macular or maculopapular generalized 
eruption appears between the fourth and 
eighth day in 25 per cent. Nonspecific gas- 
trointestinal symptoms are commonly pre- 
sent, and a generalized lymphadenopathy 
occurs in 40 per cent. The incidence of 
meningitis in these cases is not known, but 
it appears to develop on or about the 
seventh day of illness. Hepatomegaly, icter- 
us, and albuminuria may be present, but 
splenomegaly is rare. Cough is reported in 
25 per cent of the cases and pneumonitis is 
seen radiographically 19 '. From a review of 
the available literature, the pulmonary find- 
ings do not appear to have been adequately 
investigated. 

From this summary of the symptoms and 
physical findings it is clear that the syn- 
drome may mimic many common infec- 
tious diseases. It would appear that milder 
forms of leptospirosis have gone unrecog- 
nized, and it remains for us to encourage a 
search for the disease by simple laboratory 
procedures in all cases of obscure and un- 
explained febrile illnesses. 



Summary 

A case of leptospirosis caused by Lept. 
canicola is reported. It is considered to be 
the first such report from Guilford County. 

The widespread animal reservoir of in- 
fection in this state is noted. 

The diagnosis should be considered in all 
acute febrile illnesses associated with head- 
ache, temperature elevation, myalgia, con- 
junctival suffusion, pneumonitis, and where 
"asceptic meningitis" or other cerebral 
symptoms develop on or about the seventh 
day. 

It is further suggested that suitable cul- 
ture material be made available at the lo- 
cal county health level for possible earlier 
diagnosis. 

References 

1. Gochenour, W. S. Jr., and others: Leptospiral Etiology 
of Fort Bragg Fever. Public Health Rep. 67:811-813 
(Aug.) 1952. 

2. Humbert. W. C: Leptospirosis; Its Public Health Sig- 
nificance. North Carolina M. J. 16:406-409 (Sept.) 195B. 

3. Division of Epidemiology; North Carolina State Board 
of Health: Leptospirosis, Bull., State Board of Health, 
Raleigh, 1958. 

4. Hall, H. E., and others: Evaluation of Antibiotic 
Therapy in Human Leptospirosis, Ann. Int. Med. 35:981- 
998 (Nov.) 1951. (b) Fairburn. A. C. and Semple 
S. J. G. : Chloramphenicol and Penicillin in the Treat- 
ment of Leptospirosis Among British Troops in Malaya, 
Lancet 1:13-16 (Jan. 1) 1956. (c) Broom, J. C, and 
Norris, T. S.: Failure of prophylactic oral penicillin to 
inhibit a human laboratory case of leptospirosis. Lancet 
1:721-722 (April 6) 1957. (d) Russell, R. R. W.: Treat- 
ment of leptospirosis with oxytetracyclin. Lancet 2:1143- 
1145 (Nov. 29) 1958 

5. Cargill, W. H., Jr., and Beeson, P. B.: The Value of 
Spinal Fluid Examination as a Diagnostic Procedure in 
Weil's Disease, Ann. Int. Med. 27:396-400 (Sept.) 1947. 

6. (a) Sturman. R. M., Laval. J. and Weil. V. J.: Lepto- 
spiral Uveitis, A.M.A. Arch. Ophth. 61:6633-640 (April) 
1959. (b) Hanno, H. A., and Cleveland, A. F. Leptospiral 
Uveitis, Am. J. Ophth. 32:1564-1566 (Nov.) 1949. (c) 
Alexander, A., and others: Leptospiral Uveitis, A.M.A. 
Arch. Ophth. 48:292-297 (Sept.) 1952. (d) Beeson, P B., 
Hankey, D. D., and Cooper, C. F., Jr.: Leptospiral Iri- 
docyclitis; Evidence of Human Infection with Leptospira 
Pomona in United States, J. A. M. A. 145:229-230 (Jan. 
27) 1951. (e) Edwards, G. A.: Clinical Characteristics 
of Leptospirosis, Am. J. Med. 27:4-17 (July) 1959. 

7. Middleton, J. E.: Canicola Fever with Neurological Com- 
plications, Brit. M. J. 2:25-26 (July 2) 1955. 

8. Davidson, L. S. P., and Smith. J.: Weil's Disease in 
Fish-Workers; A Clinical, Chemical and Bacteriological 
Study of 40 Cases, Quart. J. Med. 5:263-286 (April) 1936. 

9. Woodard, T. E. : The Protean Manifestations of Lepto- 
spirosis. U. S. Army Medical Service Graduate School, 
Symposium on the Leptospiroses, M. Science Publication 
No. 1., U. S. Government Printing Office, Washington, 
D. C, pp. 57-71, 1953. 



.•542 



Aim-list. 1960 



Salmonella and Shigella Infections Found 
In One Hundred Ninety-five Cases of Acute Diarrhea 



E. R. Caldwell, Jr., M.D. 

and 

E. A. Abernathy, M.D. 

Statesville 



In October, 1952, it was decided that all 
patients admitted to this small general hos- 
pital with a chief complaint of diarrhea 
would have a single stool culture prior to 
the institution of any therapy. This culture 
was taken from the first stol passed, and 
therapy was then started. Blood cultures 
were made in only a few selected patients in 
whom the illness seemed more severe. Rou- 
tine blood tests (hemoglobin determination, 
red blood cell count, white blood cell count, 
and erythrocyte sedimentation rate) and 
urinalyses were carried out, but are not an- 
alyzed in this report. The study was con- 
ducted to determine the bacteriologic con- 
tent of a single stool culture. It is realized 
that in private practice one cannot pursue 
as thorough a bacteriologic analysis as would 
be possible in a teaching hospital ; however, 
we believe that a single specimen collected 
and mailed to the State Laboratory may be 
quite revealing in determining the cause of 
diarrhea in some cases. 

Results 
Table 1 shows that out of 195 cultures 23 
pathogenic organisms were isolated — an in- 
cidence of 11.8 per cent. Probably this fig- 
ure would have been higher if repeated cul- 
tures had been made. Twelve Salmonella and 
11 Shigella organisms were isolated. One 
case of Salmonella typhosa was discovered, 
but was not included in this series because 
no diarrhea was present. A diagnosis was 
made seriologically and finally proven bac- 
teriologically when a positive stool culture 
was obtained after several attempts. 



From Davis Hospital. Statesville. North Carolina. 
We are indebted to the North Carolina State L iboratory of 
Hygiene for the bacteriologic studies. 



Table 1 



I Salmone 



Montevideo 

Typhimurium 

Derby 

Enteritidis 

Senftenberg 

Javiana 

II Shigella 

Sonnei 
Flexneri 
Flexneri 
Sonnei 
Negative Cultures 
Positive Cultures 

Total Cultures 



I 

3 
6 

II 



172 
23 

195 



I Salmonella 



Typhimurium 

Montivideo 

Derby 

Enteritidis 

Senftenberg 

Javiana 

Total 



II Shigella 



Sonnei 
Sonnei 
Flexneri 
Flexneri 



II 
6 
3 



Total 



12 



5 
1 

4 
1 

II 



Conclusions 



Though trained bacteriologists are not 
available in all hospitals and private office 
laboratories, it is possible, by using avail- 
able facilities, to isolate many pathogenic 
organisms and so achieve a somewhat more 
scientific approach to our practice. It is grat- 
ifying to be able to make a definite diag- 
nosis in some of the otherwise obscure types 
of diarrhea. 



Every human being has an innate dread of illness, and brings to his 
doctor his fears, his hopes, and his confidence. Medical care is very def- 
initely a personal service. Science is a requisite but without sympathy is 
woefully inadequate. — Rouse, M.O. : Essential "Intangibles" in Medicine, 
South. M. J. 53:1 (Jan.) 1960. 



August, 1960 



EDITORALS 



343 



North Carolina Medical Journal 

Owned and published by 

The Medical Society of the State of North Carolina, 

under the direction of its Editorial Board. 

EDITORIAL BOARD 
Wingate M. Johnson, M.D., Winston-Salem 

Editor 
Miss Louise MacMillan, Winston-Salem 

Assistant Editor 
Mr. James T. Barnes, Raleigh 

Business Manager 
Ernest W. Furgurson, M.D., Plymouth 
John Borden Graham, M.D., Chapel Hill 
G. Westbrook Murphy, M.D., Asheville 
William M. Nicholson, M.D., Durham 
Robert W. Prichard, M.D., Winston-Salem 
Charles W. Styron, M.D., Raleigh 

Address manuscripts and communications regarding 
editorial matter to the 
NORTH CAROLINA MEDICAL JOURNAL 
300 South Hawthorne Road, Winston-Salem 7, N. C. 
Questions relating to subscription rates, advertis- 
ing, ect., should be addressed to the Business 
Manager, 203 Capital Club Building, Raleigh, N. C. 
All advertisements are accepted subject to the ap- 
proval of a screening committee of the State 
Journal Advertising Bureau, 510 North Dearborn 
Street, Chicago 10, Illinois, and/or by a Committee 
of the Editorial Board of the North Carolina Medi- 
cal Journal in respect to strictly local advertising 
accepted for appearance in the North Carolina 
Medical Journal. 

Annual subscription, $5.00 Single copies, 75c 1 

Publication office: Carmichael Printing Co., 1309 

Hawthorne Road, S.W., Winston-Salem 1, N. C. 

August, 1960 



NAMING NEW DRUGS 

The rapid multiplication of new drugs is 
creating a real problem for physicians, 
medical students, and pharmacists. It is 
well nigh impossible to memorize even the 
names of the hundreds of new preparations 
marketed every year — much less to learn 
their indications, contraindication, side-ef- 
fects, and dosage. The confusion is com- 
pounded by the fact that every drug has at 
least three names: chemical, generic, and 
brand. The chemical names, while admit- 
tedly more scientific, have a very limited 
application for the average medical man. 
Generic is used in the sense of Webster's 
definition, "General ; opposed to specific." 
The brand names are selected by the manu- 
facturers and are copyrighted. As an ex- 
treme example, there are more than 18 
brand names for reserpine. If a doctor pre- 
scribes a drug by its generic name, the 
druggist is not obligated to use the product 
of any one manufacturer. If, however, the 
brand name is used, the druggist must use 
the one specified. 



The manufacturers seek to justify the 
use of brand names as necessary to insure 
that the drug meets the proper standards 
in its preparation and that inferior pro- 
ducts are not sold. The widespread use of 
copyright brands, however, imposes a hard- 
ship on the doctor, who has trouble enough 
remembering simple generic names; on the 
druggist, who must carry in stock many 
forms of the generic drug ; and on the con- 
sumer, who must pay more for the addition- 
al expense entailed in marketing and adver- 
tising the product. 

The Advertising Committee of the New 
England Journal of Medicine (vol. 263:1, 
July 7, 1960) offers a most constructive so- 
lution of this problem of naming new 
drugs. A special article, "Drug Terminol- 
ogy and the Urgent Need for Reform," con- 
cludes with the following pertinent sugges- 
tions: 

The generic term must be selected and made 
available for every new drug before it is put on 
the market. This should be a requirement of the 
Food and Drug Administration. Generic names 
should be selected by a National Advisory Com- 
mittee appointed by the Food and Drug Admin- 
istration. This committee should consist of ex- 
perts in medicine, pharmacy, psychology and 
marketing. The terms must be brief and de- 
signed with regard for their dignity, visual and 
oral reception and mnemonic connotations. Cer- 
tainly, such an expert committee could design 
much better generic terminology than is at pre- 
sent available. 

Once the generic term is selected and adopted 
it must represent the highest standards avail- 
able for that product . . . Once this is done the 
physician can be certain of the drug his patient 
will receive. 

The medical profession should engage in a 
campaign to urge physicians to give generic 
names prominence in all medical writing, adver- 
tising and usage. Medical journal editors should 
join in this campaign and see to it that generic 
terminology is the terminology of choice in ad- 
vertising. 

A monthly glossary of generic names and the 
standards that they represent should be pub- 
lished in leading medical journals and perhaps 
sent to physicians by the Food and Drug Ad- 
ministration. 

Finally, many medical authorities agree that 
inclusion of the manufacturer's name after the 
generic name would in the end give him equal 
protection and even more favorable recognition 
than the present undesirable trade-name prac- 
tice. For the belief is growing that a manu- 
facturer's reputation and good will are asso- 
ciated rather with his company name than with 



344 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



fanciful copyrighted and generally inane neolog- 
isms. 

As Editor Joseph Garland comments in 
the same issue: 

If manufacturers will have only enough faith 
in themselves to rely on their institutional re- 
putation to assure the purchaser that their par- 
ticular product is an especially reliable one, they 
will almost certainly gain additional prestige 
with the professional men and women whom 
they are trying to impress. 

With the scrupulous observance of such poli- 
cies the management of drug therapy would be 
even more solidly vested in the medical profes- 
sion, where all would agree that it belongs. It 
may be expected that the advertiser who ap- 
peals to the intelligence of his professional clien- 
tele will not lose by such a display by confidence. 
It is devoutly to be wished that these 
constructive suggestions of our New Eng- 
land contemporary will be accepted. 



chiatric service. The number had increased 
to 200 by the end of World War II, in 1945, 
and by 1957 there were 584. Many more 
have let down their bars since then. In 
some of these the psychiatric division is 
closed, but in perhaps most of them it is 
open, and patients may be given insulin and 
electroshock therapy in their rooms. 

Any doctor who has had to deal with 
"borderline" cases, such as mental depres- 
sion or anxiety states, can appreciate the 
advantage of having such patients in a gen- 
eral hospital. And as the Southern Medical 
Journal editorial points out, the admission 
of psychiatric patients to a general hospital 
has educational and training value both for 
the psychiatrist and for the house staff. It 
will be gratifying to see the increasing use 
of general hospital beds for mentally ill pa- 
tients. 



THE ARTHRITIS HOAX 

The Public Affairs Committee, a nonprof- 
it organization, in cooperation with the 
Arthritis and Rheumatism Foundation, has 
prepared a 20-page pamphlet, "The Arthri- 
tis Hoax," which exposes the many ways 
by which victims of arthritis are exploited 
to the tune of more than 250 million dol- 
lars a year by worse than useless drugs, de- 
vices, and treatments, ranging from copper 
bracelets to "uranium mines," and from 
dietary fads to analgesic drugs. The pam- 
phlet is sold for 20 cents by the Public Af- 
fairs Committee— 22 East 38th Street, New 
York 16. It gives the answers to many of 
the questions that patients are apt to ask 
the doctor, and is well worth the price. 



PSYCHIATRIC PATIENTS IN 
A GENERAL HOSPITAL 

" 'Tis true, 'tis pity; and pity 'tis, 'tis 
true" that there is a certain stigma at- 
tached to being treated in a hospital de- 
voted entirely to mentally ill patients. The 
psychic trauma of such an experience may 
intensify the patient's illness — especially in 
mental depression, which is one of the most 
frequent ailments for which doctors are 
consulted. It is a cause for giving thanks 
that so many general hospitals now admit 
psychiatric patients. 

An editorial in the July Southern Medical 
Journal states that at the turn of the cen- 
tury only 25 general hospitals had a psy- 



THREE CORRECTIONS 

Three mistakes were made in the June 
issue editorial, One Hundredth Sixth An- 
nual Session. 

1. That the wrist watch presented Jim 
Barnes was a gift from the Society. The 
watch was given him by the past presidents 
who have served with him since he became 
our Executive Secretary, as a token of their 
appreciation of his ability. 

2. The statement that Billy Joe Patton 
was Dr. Leonard Larson's son-in-law. Mrs. 
Patton is a sister of Mr. John Collett of 
Lenoir, and Mrs. Collett is Dr. Larson's 
daughter. Although the editor's face is red, 
he — and all other North Carolina doctors — 
is glad to know that Dr. Larson, now Pres- 
ident-elect of the American Medical Asso- 
ciation, does have a daughter living in the 
state, who will be a strong inducement for 
him to visit us often. 

3. The most serious error was a proof- 
reading lapse. The statement that the mo- 
tion to table the resolution from the Lenoir 
Jones-Green Component Society to limit 
the term of councilors "was defeated by a 
vote of 55 to 48" should have read, "was 
passed by a vote of 55 to 48." 

Three boners in one editorial is a record 
of which the editor is thoroughly ashamed 
— and for which he has no one to blame but 
himself. He can only promise to try to do 
better in the future. 



August, 1960 



EDITORALS 



345 



DR. PRESTON— NEW EDITOR OF 
HEALTH BULLETIN 

In 1942 Dr. John H. Hamilton added to 
his other duties as Assistant State Health 
Director and Director of the State Labora- 
tory of Hygiene the editorship of The 
Health Bulletin. When the time came for 
him to retire for chronologic reasons, the 
very satisfactory way he has filled all three 
positions was recognized in an appreciation 
from the State Board of Health. This was 
published in the May Health Bulletin to- 
gether with his picture on the cover — with- 
out his knowledge or consent. This same ap- 
preciation appeared in the June issue of 
the North Carolina Medical Journal. 

The Board of Health was fortunate in 
being able to fill Dr. Hamilton's place with- 
out delay. Edwin S. Preston, M. A., LL. D., 
who has been selected to succeed Dr. Ham- 
ilton is well qualified for the position. For 
eight years he edited the Public Welfare 
News, the official publication of the North 
Carolina Board of Public Welfare. He was 
also the Welfare Board's public relations 
officer. In December, 1959, he came to the 
State Board of Health as its public rela- 
tions officer — so he is a "natural" for the 
editorship of the Bulletin. 

Dr. Preston is a graduate of the Univer- 
sity of Tennessee and has an M. A. degree 
from Mercer University. The honorary de- 
gree of LL. D. was conferred by Baylor 
University. This journal echoes the words 
used by Dr. Roy Norton in the June Health 
Bulletin, introducing him to the readers 
of the Bulletin. Dr. Norton bespoke for Dr. 
Preston "the same fine and helpful criti- 
cism and assistance that has been given to 
his predecessor by the friends who receive 
The Health Bulletin." 



"YOU ARE OLD, FATHER WILLIAM . ."* 

Not so long ago, it seems, old people were 
just old people, gentle, withering relics of 
the past typified by Whistler's portrait of 
his mother. True, they had their problems 
then, but who hadn't? Some were incapa- 
citated, other spry ; some were broke, others 
solvent; some were happy, some sad. 

Now our modern old people, more nu- 
merous than before, thanks to modern doc- 
tors, modern medical science, and modern 



•Reprinted from the New York State Journal of Medicine. 
May 15. 1960. 



private enterprise in medicine, have been 
metamorphosed. From being just old peo- 
ple they have become recently desirable, 
valuable political assets! Each has a genu- 
ine exercisable franchise; some 15,000,000 
potentially purchasable ballots ! Purchas- 
able by inducement — not in cash but by 
"benefits." 

Both major political parties are offering 
bids, the Democrats a Forand-type bill, the 
Republicans a Javits-type bill. Suddenly the 
health of the aged becomes the grave con- 
cern of others besides the doctors. 

Assuredly the old folks have not offered 
their votes for sale; the most many ask for 
is the privilege of continuing to work gain- 
fully after sixty-five, not for a pittance but 
according to their ability to earn and to pay 
their taxes, employ their own doctors, and 
buy their own insurance. 

In all the election year turmoil over the 
health of the old who hears any concern 
expressed over the employers, the business 
men, the small and large shop operators, 
and others, men who create employment for 
the young? In this election year and every 
year, many thousands of young people will 
for the first time have fastened about their 
necks the yoke of withholding taxes, Social 
Security taxes, rent, state, local taxes, union 
dues, and the national debt. The young — 
don't they enjoy the prospect of some forty- 
seven years of work-filled and tax-ridden 
pursuit of happiness? 

The young people — will they not find it 
increasingly difficult in this inflation-ridden 
election year and those to follow to buy 
bread for themselves and their children? 
Who cares? Let them eat cake! They are 
only the young. Will they find in their midst 
anyone to arise and say in a loud voice to 
politicians of both parties: Thou shalt not 
press down upon the brow of youth a crown 
of aging thorns! 



NORTH CAROLINA'S COMMITTEE 
ON MEDICAL CREDIT BUREAUS 

The May issue of the A.M.A.'s PR Doc- 
tor devotes more than two columns to a 
very favorable discussion of the work done 
by the Medical Credit Bureau Committee 
of our State Society, of which Dr. Howard 
Wilson of Raleigh is the chairman. Dr. 
Wilson and his committee deserve much 
credit for their fine work. 



340 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1900 



Committees and Organizations 



North Carolina Board of 
Medical Examiners 

THE BIENNIAL REGISTRATION ACT 

The second registration of physicians in 
North Carolina was completed in January, 
1960. The registration went along smooth- 
ly. The directory has been completed and 
mailed to each physician. However, some 
of our friends exercised their inalienable 
right to register their objections to the reg- 
istration. These, however, seemed to for- 
get that this law was sponsored by the Med- 
ical Society, under the directive of the 
House of Delegates of 1956. The complain- 
ant is usually concerned only with the fact 
that he has to pay a fee and does not con- 
sider what is best for the group as a whole. 
It is a recognized principle of all people 
who deal with licensure that registration is 
necessary to keep the records and the office 
running smoothly for the benefit of all phy- 
sicians. Registration was not put into effect 
as a revenue measure, but all the funds go 
into the treasury of the Board and thereby 
enable the Board to serve better the phy- 
sicians and all citizens of the State of 
North Carolina. 

A native son recently returned to North 
Carolina for practice. He had been away so 
long he did not know of the registration. 
When he registered, the office noted that an 
official notice had been received from the 
secretary of a board of medical examiners 
of a distant state that this physician's li- 
cense had been revoked, but sentence had 
been suspended on conditions. The Board 
has interviewed this physician. He has an 
opportunity for rehabilitation under super- 
vision. 

The law as enacted was a compromise 
draft to overcome the objections presented 
to the Legislative Committee of the Med- 
ical Society. The result has been that the 
Board has been embarrassed on a number 
of occasions by not having the power to 
waive the penalty under conditions upon 
which some people were late in registering. 
The other professions and trades in North 
Carolina controlled by a board have annual 
registration. Their fees equal or are more 
annually in the majority of the cases than 
the fee which the physician pays every two 
years. 



The Board wishes to express its appre- 
ciation to the leaders of the Medical Society 
of the State of North Carolina, to the edi- 
torial staff of our Journal, and to the 
greater majority of the physicians of this 
state who have accepted and co-operated 
with this registration. It will be our aim to 
continue to serve the citizens of our state 
in our official capacity as a part of the state 
government. 

Joseph J. Combs, M.D., Secretary 

North Carolina Board 

of Medical Examiners 



BULLETIN BOARD 



COMING MEETINGS 

State 

North Carolina and South Carolina Eye, Ear, 
Nose and Throat Societies' Annual Joint Meeting 
— Hotel King: Cotton, Greensboro, September 11-14. 

Fourth District Medical Society Meeting — Wil- 
son, September 14. 

North Carolina Urological Association, Annual 
Meeting — Greystone Inn, Roaring- Gap, September 
25-26. 

North Carolina Fifth District Medical Society 
Meeting — Mid Pines Club, Pinehurst, October 5. 

North Carolina Society for Crippled Children 
and Adults, Twenty-fifth Annual Meeting — Wash- 
ington Duke Hotel, Durham, October 6-8. 

A.M. A. Twentieth Annual Congress on Industrial 
Health— Charlotte, October 10-12. 

Duke University Medical Postgraduate Seminar 
Cruise to the West Indies — November 9-18. 

North Carolina Academy of General Practice, 
Annual Meeting — Carolina Hotel, Pinehurst, No- 
vember 27-30. 

Regional and National 

Fifth International Congress on Nutrition — ■ 
Sheraton Park and Shoreham Hotels, Washington, 
D.C., September 1-7. 

Southern Trudeau Society and Southern Tuber- 
culosis Society Meeting — Hotel Francis Marion, 
Charleston, South Carolina, September 14-16. 

A.M. A. First Regional Conference on Rural 
Health, Atlanta, Georgia, October 7-8. 

American Rhinologic Society, Sixth Annual 
Meeting — Belmont Hotel, Chicago, October 8. 

American College of Surgeons, Forty-sixth An- 
nual Clinical Congress — San Francisco, October 
10-14. 

Southeastern Allergy Association, Annual Meet- 
ing — Atlanta Biltmore Hotel, Atlanta, Georgia, 
October 21-22. 

Southern Medical Association, Fifty-fourth An- 
nual Meeting — Saint Louis, Missouri, October 31- 
November 3. 

Sixty-seventh Annual Convention of Military 



August, 1960 



BULLETIN BOARD 



347 



Surgeons — Washing-ton, D.C., October 31-Novem- 
ber 2. 

American Medical Writers' Association, Seven- 
teenth Annual Meeting — Morrison Hotel, Chicago, 
November 18-19. 

Southeastern Region of the College of Ameri- 
can Pathologists and the Virginia Society of 
Pathologists, Seminar on Kidney Diseases — John 
Marshall Hotel, Richmond, November 25-26. 



New Members of the State Society 

The following new physicians joined the Medical 
Society of the State of North Carolina daring the 
month of July. 

Dr. Charles Bodine Neal, III, Duke University 
School of Medicine, Durham; Dr. John William Or- 
mand, Jr., 309 Lancaster Avenue, Monroe; Dr. 
William Thomas Rice, 318 Mocksville Ave., Salis- 
bury; Dr. Sigurd Carl Sandzen, McCain Sanator- 
ium, McCain; Dr. Casper Carl Warren, Jr., 2016 
Pershing St., Durham; Dr. Daniel Whitaker Davis, 
1415 Ida Street, Durham; Dr. George Wesley Gen- 
try, Jr., 607 S. Main St., Roxboro; Dr. Stuart Boat- 
wright, Haywood County Hospital, Waynesville; 
Dr. Joe Walton Frazer, Jr., 838 N. Elm St., 
Greensboro; Dr. Howard Scheyer Wainer, 1001 N. 
Elm St., Greensboro; Dr. George Carl Alderman, 
1019 Hawthorne Road, Wilmington. 



News Notes from the University of 
North Carolina School of Medicine 

Several University of North Carolina School 
faculty members are engaged in mid-summer work 
in various parts of the world. 

Dr. Hans H. Strupp, director of psychological 
services in the School of Medicine, has been 
awarded a grant from the National Institute of 
Mental Health to organize a second conference on 
research in psychotherapy to be held in Chapel 
Hill next spring. The conference will be sponsored 
by the American Psychological Association. 

Dr. Carl E. Anderson, professor of biochemistry, 
is serving as a visiting- scientist in the laboratory 
of nutrition and endocrinology at the National In- 
stitutes of Health in Bethesda, Maryland. 

Dr. Colin G. Thomas, Jr., associate professor of 
surgery, and Dr. Judson J. Van Wyk, associate 
professor of pediatrics, are in London to partici- 
pate in the fourth International Goiter Conference 
meeting. 

Dr. Ernest Craige, associate professor in the 
Department of Medicine, has returned from South 
America where he served as a visiting professor 
in the Department of Internal Medicine at the 
University of Del Valle in Cali, Colombia. 

Leaving in August for Alexandria, Egypt, Dr. 
Sidney S. Chipman, clinical professor of pediatrics, 
will begin a one-year foreign teaching assignment 
sponsored by the World Health Organization. He 
will act as a visiting professor of social pediatrics 
at the Higher Institute of Public Health. 



A recent issue of a Swiss medical journal con- 
tains an article by Dr. John A. Ewing, associate 
professor of psychiatry at the University of North 
Carolina School of Medicine. 

The article, entitled "Nos malades et nos con- 
tacts personnels avec eux," appears in Medecine 
et Hygiene, which is printed in Geneva. 

In his paper Dr. Ewing explains how the phy- 
sician needs to learn to observe his feelings about 
his patients. Some feelings may arise because of 
factors within the doctor, or his patient may re- 
mind him of someone else. Some patients frequent- 
ly provoke special feelings in other people in al- 
most all personal contacts. 

If the physician is to control the relationship 
and to use it for therapeutic purposes, he must 
observe and identify his feelings about his patient, 
Dr. Ewing- points out. The way the patient 
"makes" the doctor feel about him can be seen as 
similar to any symptom about which the patient 
may complain. The physician needs to understand 
this aspect of the patient as much as anything 
else he finds in his examination, he said. 

* * * 

Dr. John K. Spitznagel of the University of 
North Carolina School of Medicine recently gave 
a seminar at the University of Florida in Gaines- 
ville, Florida, where he spoke on "The Role of 
Basic Proteins in Non-specific Resistence to In- 
fection." 

Dr. John H. Schwab, assistant professor of bac- 
teriology of the University of North Carolina 
School of Medicine, has gone to England to do a 
year's research at the Lister Institute of Preven- 
tive Medicine in London. He will work in the area 
of natural resistence to infections. 

* * * 

A new brochure has been issued by the Univer- 
sity of North Carolina Division of Health Affairs 
which gives a thumbnail sketch of the various edu- 
cational programs being offered by the University 
Medical Center. 

Designed primarily for high school and junior 
colleg-e students, the illustrated brochure ranges 
in content matter from the one-year training pro- 
gram for dental assistants to the specialized pro- 
grams for medical doctors. 

Copies are available to students, educators and 
other interested persons. They may be obtained by 
writing to the U.N.C. Director of Admissions or 
to the School of Medicine. 

Ellen Anderson of the University of North Car- 
olina School of Medicine was named president- 
elect of the American Society of Medical Tech- 
nologists at the annual convention of the organi- 
zation in Atlantic City, New Jersey recently. 

She will hold this office for one year and then 
be installed as president of the professional society, 
which has 8,000 members. The convention was at- 
tended by 2,000 medical technologists. 



:: is 



NORTH CAROLINA MEDICAL JOURNAL 



Aujrust. 1960 



Since 1953 Miss Anderson has been chief cyto- 
technologist in the Department of Pathology and 
at the North Carolina Memorial Hospital. 

* * :!= 

Four faculty members of the section of Physical 
Therapy of the University of North Carolina 
School of Medicine attended the national confer- 
ence of the American Physical Therapy Associa- 
tion in Pittsburgh recently. They were Miss Mar- 
garet Moore, head of the section; Miss Rachel 
Nunley, Miss Mildred Wood, and Miss Enola Sue 
Flowers. 

Miss Moore addressed the Public Health Section 
of the Conference on "Public Health in Physical 
Therapy Education." She also attended a number 
of sessions of the Council of Physical Therapy 
School Directors, which also met in Pittsburgh 
during- the association meeting. 

Miss Wood is chairman of the Committee on 
Graduate Study of the American Physical Therapy 
Association and she reported on the activities of 
the association in this field. 

Dr. Charles E. Flowers of the Department of 
Obstetrics and Gynecology addressed a meeting 
of the Continental Gynecologic Society in Mon- 
treal, Canada, on June 27-28. His topic was "Mag- 
nesium Sulfate Therapy During Pregnancy." 

Dr. Harrie R. Chamberlin of the Department of 
Pediatrics spoke before a seminar at the West 
Virginia University School of Medicine in Mor- 
ganton, West Virginia on June 29-30. His topic- 
was "Intrauterine Development and Environment." 
The seminar is sponsored by the West Virginia 
State Department of Health and the Children's 
Bureau of the U. S. Department of Health, Educa- 
tion and Welfare. 

* * * 

A new book entitled "Psychotherapists in Ac- 
tion" has been published concerning the research 
program being conducted by an associate professor 
of psychology in the Department of Psychiatry at 
the University of North Cai-olina School of Medi- 
cine. 

The work is by Dr. Hans H. Strupp, who also 
is director of psychological services of North Car- 
olina Memorial Hospital here at the University. 
The publishers are Grune and Stratton of New 
York. 

This volume deals with how psychiatrists and 
psychologists arrive at various conclusions and 
judgments on the cases which they are treating 
psychologically, and how they communicate with 
their patients. 

Dr. Strupp worked with some 200 psychothera- 
pists in collecting- material for this book. Selected 
reports from some 40 of these persons are con- 
tained in this volume. 

* * * 

Dr. Carl W. Gottschalk, associate professor of 
medicine, is transferring his research relating to 
kidney functions from Chapel Hill to the Univer- 



sity of Copenhagen, Denmark, for a period of one 
year. 

In Denmark, Dr. Gottschalk will be associated 
with Dr. Hans Ussing of the Institute of Biolog- 
ical Chemistry at the University of Copenhagen. 
The year's program is co-sponsored by the Amer- 
ican Heart Association and the U. S. Public Health 
Service. 



News Notes from the Bowman Gray 
School of Medicine of 
Wake Forest College 

Dr. Donald M. Hayes, instructor in medicine, 
has been appointed assistant dean of the Bowman 
Gray School of Medicine. In his new work, Dr. 
Hayes will be responsible for student admissions 
and premedical relations. He will continue as a 
full-time member of the Department of Internal 
Medicine with active participation in teaching, and 
research in hematology. 

Dr. Hayes is a 1951 graduate of Wake Forest 
College and received his medical degree from 
Bowman Gray. He has taken postgraduate train- 
ing in medicine at the Salt Lake County General 
Hospital, Salt Lake City, Utah, and served as a 
U. S. Public Health Service Fellow in Psychiatry 
for one year at the Louisville General Hospital, 
Louisville, Kentucky. In 1958 he completed his in- 
ternal medicine residency at the North Carolina 
Baptist Hospital. 

For the past two years Dr. Hayes has served 
as a hematologic fellow in medicine at Bowman 
Gray, and for the past year has been instructor in 

medicine. 

* * * 

A total of $19,440 has been received for five 
cancer traineeships for young physicians in the 
Departments of Medicine, Obstetrics-Gynecology, 
Pathology, Radiology, and Surgery at the Bowman 
Gray School of Medicine. 

This training program has been established by 
the National Cancer Institute in order to increase 
the number of persons with broad medical exper- 
ience and special orientation in cancer. 

The recipients of the traineeships for this year 
are: Drs. Edwin L. Auman, Department of Medi- 
cine; J. Howard Young, Department of Obstetrics- 
Gynecology; Robert S. Pool, Department of Pa- 
thology; Samuel D. Pendergrass, Department of 
Radiology; and Richard F. Bowling, Department 
of Surgei-y. 

Dr. Camillo Artom, professor of biochemistry, 
and Dr. Hugh B. Lofland, assistant professor of 
biochemistry, are the co-authors of a paper which 
was presented at the Fifth Conference on the Bio- 
chemical Problems of Lipids held in Marseilles, 
France, July 21-23. The title of their paper is 
"Incorporation of Ethanolamine and Phosphory- 
lethanolamine into the Phospholipids of Liver 
Preparations." 



August, 1960 



BULLETIN BOARD 



349 



Dr. Richard G. Kessel, instructor in anatomy, 
has been awarded a postdoctoral fellowship by the 
Division of General Medical Sciences of the U. S. 
Public Health Service. These fellowships are 
awarded to assist in the development of promising- 
investigators in basic science fields. Dr. Kessel's 
special research interest and training have been 

in electron microscopy. 

* * * 

The U. S. Public Health Service has awarded a 
grant of $19,665 to Dr. Robert P. Morehead, di- 
rector of the Department of Pathology, and Dr. 
J. H. Smith Foushee, assistant professor of 
pathology. The official title of the grant is, "Com- 
munity Cancer Demonstration Project Grant to 
Train Cytotechnicians." 

For some time now, the Bowman Gray School 
of Medicine has supported the training of a lim- 
ited number of student in exfoliative cytotechnol- 
ogy, and this grant will permit expansion of the 
training program and an increase in the number 
of students. 



News Notes from the Duke University 
Medical Center 

A pilot study aimed at helping persons disfig- 
ured by injury or disease has been initiated at the 
Duke University Medical Center. 

The study is being conducted by the Center's 
Department of Medical Art and Illustration with 
financial support from the Office of Vocational Re- 
habilitation, U. S. Department of Health, Educa- 
tion and Welfare. Prof. Elon Clark is head of the 
department. 

Purpose of the project is to work toward the 
production of better artificial noses, and other 
parts of the face. 

Research funds amounting to $39,900 have been 
awarded to Duke University by the National 
Science Foundation to support continuing investi- 
gations of brain functions. 

Dr. Talmadge L. Peele, associate professor of 
anatomy in the Duke Medical Center, is pi-incipal 
investigator for the project. Entitled "Interde- 
pendence of Amygdala and Hypothalamus," the 
research study is concerned with learning more 
about the relationships between these two parts 
of the brain. 

F. Ross Porter, director of the Duke Medical 
Center Foundation, has resigned to accept a posi- 
tion as hospital advisor with the International Co- 
operation Administration. 

He will begin his first assignment in Bogota, 
Colombia, early next year after several months of 
orientation and other preparation. His duties will 
be to work with the ICA and the Colombian gov- 
ernment in developing a national pattern for im- 
provement of hospital and health services in Co- 
lombia. 



A.M.A. INDUSTRIAL HEALTH CONGRESS 
The Twentieth Annual Congress on Industrial 
Health will be held in Charlotte, North Carolina, 
October 10-12, under the sponsorship of the Coun- 
cil on Occupational Health of the American Med- 
ical Association. 

The program will include discussions of occupa- 
tional health in agriculture, mental and emotional 
health in industry, problems in dermatitis in farm 
and industry, and occupational health problems in 
small employee groups. 

Established in 1938, the council supports safe 
and healthful working- conditions for employees 
through medical supervision of workers, control of 
environment, health education, and counseling, ac- 
cording to B. Dixon Holland, M.D., council secre- 
tary. The congress is sponsored each year by the 
American Medical Assciation as a means of fur- 
thering the development and maintenance of high 
medical standards in industry and on the farm. 

Approved for Category II credit for members of 
the American Academy of General Practice, the 
program is primarily directed toward the general 
practitioner, whom, it is estimated, handles close 
to 90 per cent of all the occupational medical 
practice in the nation. 

Presiding over the opening session of the con- 
gress will be Dr. William P. Shepard of New York 
City, chairman of the A.M.A. Council on Occupa- 
tional Health. The meeting will begin at 2:00 p.m. 
on Monday afternoon with Dr. Amos N. Johnson 
of Garland, president of the Medical Society of the 
State of North Carolina, as the first principal 
speaker. The sessions continue through Wednesday 
morning, including formal presentations by na- 
tionally known speakers. 

Cooperating sponsors include the Medical Society 
of the State of North Carolina, the Governor's 
Council on Occupational Health, the Mecklenburg 
County Medical Society, and the Greater Charlotte 
Occupational Health Council. 



North Carolina Academy of 
General Practice 

The annual meeting of the North Carolina Acad- 
emy of General Practice will be held at the Caro- 
lina Hotel in Pinehurst, November 27-30. 

The scientific sessions will be held daily from 
9:00 a.m. to 12:30 p.m., leaving the afternoons free 
for audiovisual presentations, golf, or relaxation 
among friends. 



Fourth District Medical Society 

The Fourth District Medical Society will meet in 
Wilson on September 14 at 6:30 p.m. Dr. Franklin 
L. Angell of Roanoke, Virginia, will speak on the 
subject "Premature Cranial Synostosis." 



350 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



Edgecombe-Nash Medical Society 

The Edgecombe-Nash Medical Society met on 
July 13 in Rocky Mount. 

Dr. R. D. Komegay, program chairman for July, 
presented Dr. James Ralph Dunn, Jr., who spoke 
on the subject of vascular surgery. 



News Notes 

Dr. Robert E. Nolan has announced the opening 
of his office at the O'Hanlon Building in Winston- 
Salem. His practice will be limited to general 
surgery. 



Southeastern Allergy Association 

The Southeastern Allergy Association will 
hold its annual meeting at the Atlanta Biltmore 
Hotel, Atlanta, Georgia, October 21 and 22, 1960. 

Dr. Susan Dees, Duke Medical Center, Durham, 
North Carolina is in charge of the program. Every- 
one interested in allergy is invited to attend. 



Southern Medical Association 

A complete history of the 54-year old Southern 
Medical Association comes off the press August 
15. 

Its author is C. P. Loranz, Birmingham, for 
many years business manager and secretary-man- 
ager of Southern Medical, now advisor and pro- 
fessional relations counselor. 

The history details the association's growth 
from its beginning in 1906, and includes statistical 
data on officers, places of meeting, research 
awards and membership figures, in addition to 
numerous photographs. 



Georgia Warm Springs Foundation 

Preliminary steps in a projected program to 
convert the famed Georgia Warm Springs Founda- 
tion into a general vocational rehabilitation center 
serving the southeastern United States were an- 
nounced recently. 

With the decline in polio that has followed the 
advent of the Salk vaccine five years ago, Warm 
Springs has begun to utilize its vast rehabilitation 
facilities to care for physical handicaps caused 
by arthritis, birth defects, spinal cord lesions, cere- 
bral vascular accidents, multiple sclerosis, and 
other disabling neuromuscular disorders. 



Seminar on Kidney Disease 

The Southeastern Region of the College of 
American Pathologists and the Virginia Society of 
Pathologists will hold a joint meeting at the John 
Marshall Hotel in Richmond, Virginia, on Novem- 
ber 25 and 26, 1960, on kidney disease. The 
speakers will include Drs. Stanley M. Kurtz, Peter 
P. Ladewig, Henry D. Mcintosh, George Margolis, 
Conrad L. Pirani, David E. Smith, and Max Wach- 
stein. The slide seminar will be conducted by Drs. 



Paul Kimmelstiel and Solomon Papper. The din- 
ner speaker will be Dr. Frank C. Coleman, pres- 
ident of the College of American Pathologists. 

The slide sets for this seminar on kidney disease 
may be purchased at a cost of $15.00 per set by 
writing to: Dr. G. T. Mann, Professor of Forensic 
Pathology, P. O. Box 41, Medical College of Vir- 
ginia, Richmond 19, Virginia. 



American Society for Clinical Nutrition 

The formation of a new professional association, 
the American Society for Clinical Nutrition, was 
announced during the meetings of the American 
Society for Clinical Investigation and the Amer- 
ican Federation for Clinical Research in Atlantic 
City recently. Arrangements are being made to 
affiliate the A. S.C.N, with the American Institute 
for Niu-ition. 

Richard W. Vilter, M.D., professor of medicine 
and chairman of the department, University of 
Cincinnati, College of Medicine, was elected presi- 
dent of the A. S.C.N, by the charter members at 
the organization's first meeting. 

A four-point list of objectives adopted at the 
first meeting states that the A. S.C.N, shall: 

1. Foster high standards for research on human 
nutrition. 

2. Promote undergraduate and graduate educa- 
tion in human nutrition. 

3. Provide a place and opportunity for research 
workers on problems of human nutrition to 
present and discuss their research activities 
and results. 

4. Provide a journal for the publication of mer- 
itorious work on human nutrition. 

The organizing group plans to adopt The Amer- 
ican Journal of Clinical Nutrition as its official 
publication. The journal is published by the Yorke 
Group, a subsidiary of the Reuben H. Donnelley 
Corporation. 



AMERICAN RHINOLOGIC SOCIETY 

The American Rhinologic Society will hold its 
sixth annual meeting at the Belmont Hotel, Chi- 
cago, October 8. Physicians are invited; there is 
no registration fee. 

The guest of honor and one of the afternoon 
speakers will be Dr. Henry L. Williams of the 
Mayo Clinic, Rochester, Minnesota, whose subject 
will be "Thirty Years of Experience in Rhinology." 
The dinner speaker will be Dr. Morris Fishbein, 
Chicago, who will speak on "Fifty Years of Medical 
Progress." 

A two-day surgical seminar in the Illinois Ma- 
sonic Hospital, Chicago, will immediately precede 
the annual meeting. 

For information, write Dr. Robert M. Hansen, 
secretary, American Rhinologic Society, 1735 
North Wheeler Avenue, Portland 17, Oregon. 



August, 1960 



BULLETIN BOARD 



351 



National Tuberculosis Association 

A potential danger in the long-term use of ster- 
oid hormones was dramatized in a special exhibit 
prepared by the National Tuberculosis Association 
for the one hundred ninth annual meeting of the 
American Medical Association in Miami Beach. 

On view before the A.M. A. members for the 
first time, the exhibit, entitled "Steroids Activate 
TB," reminded physicians that cortisone and re- 
lated drugs can activate unsuspected latent tuber- 
culosis. 

The N.T.A. exhibit, winner of an. A.M. A. Honor- 
able Mention award, was prepared under the di- 
rection of Dr. Julius L. Wilson and Dr. Floyd M. 
Feldmann of the American Thoracic Society 
(N.T.A. Medical Section). 



Fifth International Congress 
on Nutrition 

Nutrition scientists from all over the world will 
participate in the Fifth International Congress on 
Nutrition to be held in Washington, D. C, Sep- 
tember 1-7, 1960. An all-day symposium on "World 
Food Needs and Food Resources'' will be one of 
the main features of the scientific program. The 
remainder of the program will consist of seven 
half-day panel discussions by invited participants, 
and special sessions of 10-minute papers reporting 
unpublished original research. Headquarter hotels 
will be the Sheraton Park and Shoreham hotels. 



American Urological Association 

The American Urological Association offers an 
annual award of $1,000 (first prize of $500, sec- 
ond prize $300, and third prize $200) for essays 
on the result of some clinical or laboratory re- 
search in urology. Competition is limited to urolo- 
gists who have been graduated not more than 10 
years, and to hospital interns and residents doing 
research work in urology. 

The first prize essay will appear on the program 
of the forthcoming meeting of the American Uro- 
logical Association, to be held at the Hotel Bilt- 
more, Los Angeles, California, May 22-25, 1961. 

For full particulars write the Executive Secre- 
tary, William P. Didusch, 1120 North Charles 
Street, Baltimore, Maryland. Essays must be in 
his hands before December 1, 1960. 



World Congress of Psychiatry 

The Third World Congress of Psychiatry, June 
4-10, 1961, Montreal, Canada, is being held at the 
invitation of McGill University and under the aus- 
pices of the Canadian Psychiatric Association. 
Meeting on the American Continent for the first 
time, the Congress is expected to attract some 
3,000 delegates from 62 nations. Representatives 
will come from psychiatry and such allied fields 
as general medical practice, psychology, biochem- 
istry, nursing, sociology, anthropology, social work, 
and pharmacology. 



Copies of the Second Announcement, which carry 
information regarding program and registration, 
may be obtained by writing the General Secretary, 
III World Congress of Psychiatry. 1025 Pine Ave- 
nue West, Montreal 2, P.Q., Canada. 



World Medical Association 

The Secretary General of The World Medical 
Association announced that Dr. Ernst Fromm, 
treasurer of the Association, transmitted a check 
for $1000 to the Secretary of the Colegio Medico de 
Chile to be used to provide medical assistance re- 
lief to the earthquake victims in Chile. Medical 
associations and doctors of the world are urged to 
provide medical supplies and funds for the relief 
of these victims. Assistance should be addressed 
to: 

Dr. Rolando Castanon 
Colegio Medico de Chile 
Miraflores No. 464 
Santiago, Chile 



u. s. department of 
Health, Education, and Welfare 

Food and Drug Administration 

Stronger regulations to insure that physicians 
receive adequate information about the drugs they 
prescribe and to insure the safety of new drugs 
have been proposed by the Food and Drug Ad- 
ministration. 

The new regulations would: 

(1) Require sweeping changes in the labeling of 
prescription drugs. Virtually all prescription drug 
packages and printed matter distributed to phy- 
sicians to promote sale of a drug would be required 
to bear complete information for professional use 
of the drug, including information about any haz- 
ards, side effects or necessary precautions. The 
only exception in the proposed regulations would 
apply to frequently used medicines that are com- 
monly familiar to the doctor. 

(2) Provide that when safety requires, a new 
drug would be kept off the market until the man- 
ufacturer's representations regarding the reliabil- 
ity of manufacturing methods, facilities and con- 
trols have been confirmed by a factory inspection 
by the Food and Drug Administration. 

Other proposed labeling changes would require 
drugs for injection and for use in the eyes to bear 
a quantitative declaration of all inactive ingredi- 
ents. Labels of all prescription drugs would be re- 
quired to include an "identifying lot or control 
number from which it is possible to determine the 
complete manufacturing history of the drug." 

Commenting on the proposed regulations, George 
P. Larrick, Commissioner of Food and Drugs, said: 

"The large number of new medications has made 
it increasingly difficult for doctors and pharmacists 
to keep adequately informed about them. We are 
hopeful that the proposed regulations will improve 
the communication of vitally necessary informa- 



352 



NORTH CAROLINA MEDICAL JOURNAL 



August, I960 



tion and bring- about a general improvement in 
drug promotion practices. At the same time, they 
should furnish a basis for more effective govern- 
ment control where necessary." 

Interested persons are invited to submit written 
comments on the proposed regulations to the 
Hearing Clerk, Department of Health, Education 
and Welfare, Room 5440, 330 Independence Ave., 
S.W., Washington 25, D. C , within 60 days from 
the date of publication in the Federal Register. 

Nursing homes throughout the Nation report a 
wide range in daily operating costs, according to 
a Public Health Service publication released re- 
cently. 

The booklet, "Costs of Operating Nursing 
Homes and Related Facilities," cites costs from 
36 studies in nursing homes, homes for the aged, 
and boarding homes under proprietary, nonprofit, 
and public auspices. 

The report is available from the Superintendent 
of Documents, U. S. Government Printing Office, 
Washington 25, D. C, for 20 cents a copy. 



Veterans Administration 

Further progress in establishing the cause and 
treatment of cardiac arrest (heart stoppage), a 
dreaded complication of surgery, had been made 



by doctors at the Brooklyn, New York, Veterans 
Administration hospital. 

A major factor, the research group feels, is 
"potassium intoxication" induced by massive blood 
transfusions. 

If sudden heart stoppage occurs during surgery, 
it is often a lethal complication even though 
massage of the heart is instituted shortly after the 
standstill occurs, according to Dr. Harry H. Le- 
Veen of the Brooklyn VA hospital. 

He and a team of research workers from this 
hospital and the State University of New York 
reported their findings in the June 18 issue of the 
Journal of the American Medical Association. 

Their attention was focused on blood transfu- 
sions when they noticed that cardiac arrest oc- 
curred in several patients following massive trans- 
fusions. 

A major new instrument for atomic medicine 
has been installed at the Veterans Administration 
center in Los Angeles, the VA announced recently. 

Known as a human-body radiation counting 
system, the 25-ton steel room, with instrumenta- 
tion, makes possible measurement of the amount 
of radiation present in the body from fallout, med- 
ical dosage, handling radioactive materials, or 
other sources. 




presenting: modern, easy to use aerosol 

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pantothenylol .... 2% 

the dramatic inflammatory-suppressive, antipruritic, antiallergic 
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August, 1960 



BULLETIN BOARD 



353 



Dr. William H. Blahd, chief of radioisotope 
service at the center, said the counter will be used 
in diagnosis and medical research and will be an 
important resource for civil defense. 

Red Cross Gives Safety Hints 

Don't be a vital statistic this summer or fall. 

This was the Red Cross warning to the millions 
of Americans who will spend coming weekends 
taking to the water. 

A. W. Cantwell, National Director of Red Cross 
Safety Services, gave these safety hints for 
Americans interested in aquatics: 

1. Learn to swim. 

2. Make sure someone is near to help you if 
you get in trouble. 

3. Swim in a safe place. 

4. Know the swimming area. 

5. Don't go beyond safe limits or your ability. 

6. Try to stay calm in case of trouble. 

7. Keep safety equipment in your boat or canoe. 
Non-swimmers should wear life vests when riding 
in a small craft. 

8. As a general rule stay with your boat or 
canoe. Most small craft will float, even when filled 
with water or overturned 

9. Don't overload your boat. 

10. Don't "overpower" your boat. A motor too 
powerful for your boat makes it difficult to control. 



Ten Rules for Cataract Patients 

Ten rules for persons who have had cataracts 
removed from their eyes are offered by a physician 
who has undergone the surgery. 

James M. Mackintosh, M.D., director of educa- 
tion and training for the World Health Organ- 
ization, Geneva, Switzerland, outlined them in 
Hospitals, Journal of the American Hospital As- 
sociation. 

Dr. Mackintosh's rules are: 

— Leave your glasses where you can find them 
easily. This applies especially to the bedside at 
night. 

— Keep a spare pair of glasses in a well-marked 
place known to wife, secretary, and self. 

— On entering a room, survey the scene quickly 
to detect hidden perils like footstools, low chairs, 
small children lying on the floor, and other tripping 
hazards near the ground. 

— Look around the room to see who is there or you 
may completely miss one of its inhabitants. 

— Before getting up, make another quick survey 
in case someone has placed a drink on a table below 
your level of vision. 

— -When walking and you meet someone you 
know, turn your head rapidly from right to left to 
make sure that he is not accompanied. 



push-button control in 



SklTl inflammation, 

itching, 
allergy 

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This non-occlusive foam lets the skin "breathe" as it 

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non-traumatizing way to provide prompt relief and healing in . . . 

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neurodermatitis 
pruritus ani et vulvae 
stasis dermatitis 



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Arltneton-Fiink Laboratories, division • 250 East 43rd Street, New York 17, N. Y. 



354 



NORTH CAROLINA MEDICAL JOURNAL 



August. 1960 



— In traffic always look several times to left 
and right before crossing. 

— Avoid occupations that require a great deal of 
bending, such as gardening, automobile repairs, 
and lifting heavy articles. 

— Don't try to read too long at one time. A half- 
hour spell, followed by a rest of 10 minutes, is 
generally enough. The rest period must not be filled 
with other eye-straining activities such as television 
or sewing. 

— Avoid contemplating rapidly moving objects, 
such as movies or swiftly moving games, if this 
gives a sense of strain. 

Carbocaine Called Big 
Advance In Anesthetics 

A potent new local anesthetic, described as a 
marked advance in its field following extensive 
pharmacologic and clinical studies over the past 
three years in the United States, Sweden, Den- 
mark, Germany and other countries, has been 
made available to the medical profession in this 
country. 

The new anesthetic agent is called Carbocaine, 
and is a product of Winthrop Laboratories. 

It has a number of advantages as a local anes- 
thetic, chiefly its wide usefulness, high potency, 
safety and suitability for use without epinephrine, 
the vasoconstrictor. 

Carbocaine has also been found to be extremely 
stable, enabling solutions to be autoclaved re- 
peatedly or stored for long periods without danger 
of decomposition. 



Classified Advertisements 

X-RAY Equipment for sale or exchange. 100 K.V. 
100 M.A. Picker Radiographic unit with manual 
operated tilt table combined with Fluoroscope 
unit beneath the table. Provides instant change 
over from Fluoroscopy to Radiography with spot 
film device. Has had some use but is in excellent 
working order also dark room equipment, mag- 
netic type plate changer, Stereoscopic view boxes, 
etc., will consider late model Ultra-violet lamp, 
surgical endotherm in exchange. Write Box 790, 
Raleigh, North Carolina. 

AVAILABLE Desirable twelve hundred and fifty 
square feet space suitable for doctors or dentist. 
Ground floor Cameron Court apartments, corner 
Snow and Morgan Streets, Raleigh. Air con- 
ditioned, also heat, lights, water and parking. 
On long lease will improve to suit tenant. Apply 
A. W. Criddle, Manager, Temple 2-5395. 

DESIRABLE LOCATION for a physician. Contact 
Godley Realty Company, Mt. Holly Road. Char- 
lotte. North Carolina. 

WANTED Otolaryngologist and or Ophthalmolo- 
gist for extremely successful Asheville and 
Western Carolina practice. Dr. Joseph McGowan 
recently deceased. Fully equipped office, exper- 
ienced personnel. Contact Mrs. Joseph McGowan, 
303 Vanderbilt Road, Asheville, North Carolina. 



BOOK REVIEWS 

A Doctor in Many Lands. By Aldo Castel- 

lani. 319 pages, plus 30 pages appendices. 

Price, $4.95. Garden City, New York: 

Doubleday and Company, 19(50. 
Even in the antibiotic era most physicians have 
heard of Castellani's mixture as a virtuous pre- 
paration for fungal dermatoses, but fewer medical 
men know much more about the contributions of 
this extremely active man. Now over 80 years old, 
Dr. Castellani has set down anecdotal reminis- 
cences of a lively career on several continents. 
Born and educated in Italy, he had further train- 
ing in Germany, then went to England, casting his 
fortunes with the Empire in Africa and Ceylon 
until the 1914-1918 war. After service with the 
Italian Navy, he spent some time in Poland, then 
resumed practice and teaching in London, Rome 
and New Orleans (at Tulane and Louisiana State.) 
During those years he had a large clinical prac- 
tice in addition to his laboratory work, he at- 
tended many famous people, furnishing the back- 
ground for amusing accounts about them. He was 
very active with the Italian military during the 
Ethiopian war. Still an Italian citizen, and this 
time on the side opposite his British friends, Cas- 
tellani again returned to Italy for the 1939-1945 
war, seeing service in Europe and Africa. Follow- 
ing the war he went into exile with the Italian 
royal family and now lives in Portugal. 

Castellani's autobiography does not really tell 
a great deal about Castellani, dealing largely with 
his environment and his patients. As an example, 
he mentions his marriage, his wife, and daughter 
in two paragraphs early in the book, and never 
again. He is at some pains to make clear his con- 
tributions in the discovery of the causative role 
of trypanosomes in African sleeping sickness, and 
various other original observations, and deals 
briefly with the circumstances of their discovery. 
One is impressed with the unflagging zeal and 
curiosity he has brought to every task. Not satis- 
fied with enjoying the golden beauty spots so 
piized by Singhalese women he took some scrap- 
ings from them and found they were fungus col- 
onies!! Literary and poetic circles in Ceylon did 
not receive this news enthusiastically, he remarks. 
Castellani's remarks about Italian politicians, 
royalty, and military men are especially interest- 
ing. To the end, Castellani is a royalist, and his 
praise of royalty is unbounded and unashamed. 
Many of the famous Italians of this century have 
been his patients, and from his long acquaintance 
he draws many pages of remarks. Mussolini ap- 
pears as a dedicated and capable man in his early 
career, corrupted and ruined by the Germans. The 
Ethiopian campaign is presented as a sort of an 
armed cultural and economic mission, which was 
largely beneficial to the Ethiopians. Castellani 
feels that the success of the Italian campaign was 
in large part due to adequate medical preparation 
for a tropical war. He later discusses the adverse 



August, 1960 



BOOK REVIEWS 



355 



effect of the lack of adequate medical care in the 
desert campaigns of the second World War. The 
appendices deal with "Climate and Its Influence" 
and "Medical Aspects of the Ethiopian Campaign." 
The book is a pleasant day's reading for a sum- 
mer vacation, and would make an excellent gift 
for anyone interested in an urbane, gossipy, and 
intelligent physician's account of a life well spent 
and still in progress. 



Rudolph Matas: A Biography of One of 
the Great Pioneers in Surgery. By Isidore 
Cohn, M. D., with Hermann B. Deutsch. 
431 pages. Price, $5.95. Garden City, New 
York: Doubleday & Company, Inc., 1960. 

The subject of this biography provided a wealth 
of material for the author, since Rudolph Matas 
was not only one of the great surgeons of the 
world, but also a prolific writer of medical articles 
and one of the pioneers who crusaded to rid the 
world of yellow fever. 

The author has taken all the skeins of Dr. 
Matas' life and woven them into a splendid and 
enchanting story, one of the threads being the his- 
tory of the conquest of Bronze John. Much of the 
political history of New Orleans and Louisiana 
during the ninety-seven years that Dr. Matas 
lived is gathered together in this volume. 

Dr. Cohn is to be congratulated on his ability to 
bring out the true personality of this great sur- 
geon and man. All students of medicine and per- 
sons interested in history and the history of medi- 
cine will be delighted to read this magnificent 
story. 



New Teaching Film Released by SK&F 

"Resuscitation of the Newborn," the first in a 
new series of Medical Teaching Films to be pro- 
duced semi-annually by Smith Kline and French 
Laboratories, was released to the medical pro- 
fession recently. 

Made under the medical direction of the Special 
Committee on Infant Mortality of the Medical 
Society of New York County, the color film illus- 
trates essential techniques and principles for the 
resuscitation of infants who do not breathe, or 
whose breathing is impaired, at birth. 

Two other educational films, produced before 
the two-a-year program was begun, have been 
incorporated into the SK&F Teaching Film Series. 
They are "Recognition and Management of Re- 
spiratory Acidosis," and "Human Gastric Func- 
tion." 

Prints of "Resuscitation of the Newborn," as 
with the other two films in the new series, may 
be obtained on free loan from Smith Kline and 
French Professional Service and Hospital Repre- 
sentatives, or directly from the Smith Kline and 
French Medical Film Center, Philadelphia 1, Pa. 



The Month in Washington 

Congress returned to work this month to 
take up its unfinished business, including 
the controversial issue of health care for 
the aged, in an atmosphere dominated by 
election-year politics. 

The three or four week, tag-end session 
of Congress loomed as one of the most im- 
portant meetings in the past decade as far 
as possible impact on the medical profes- 
sion is concerned. 

The lawmakers are slated to decide 
whether to embark the federal government 
on a course that could threaten the private 
practice of medicine, or to adopt a volun- 
tary program that would pose no such dan- 
ger. 

The omnibus social security bill approved 
by the House Ways and Means Committee 
was easily cleared by the House, 381 to 23, 
and sent to the Senate Finance Committee, 
which held two days of hearings. The 
measure contained a voluntary, federal- 
state program for assisting needy aged 
persons meet their health care costs. Both 
the Administration and the American Med- 
ical Association endorsed the House mea- 
sure as in keeping with the concept of giv- 
ing the states prime responsibility for 
helping their citizens, for aiding those who 
are most in need of help, and for avoiding 
the compulsory aspects of health plans in- 
volving the social security mechanism. 

A vote by the Finance Committee, headed 
by Senator Harry F. Byrd, (D., Va.) was 
scheduled shortly after the Senate resumed 
operations in August. Whatever action the 
Committee took, however, proponents of 
schemes such as the Forand bill to provide 
a compulsory, federal medical program 
promised a determined fight on the floor of 
the Senate. 

In the event Congress should approve a 
government medicine plan, opponents were 
counting on a Presidential veto to kill the 
measure. The Chief Executive repeatedly 
has asserted in strong language his all-out 
opposition to any compulsory plan for 
health care financing. 

At the Senate Finance Committee hear- 
ing, Arthur S. Flemming, Secretary of 
Health, Education and Welfare, renewed 
the Administration's flat stand against the 
social security avenue to financing health 



From the Washington Office of the American Medical As- 
sociation. 



356 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



costs. Such a plan, he said, would inevit- 
ably lead to pressures for expanding the 
benefits and lowering or eliminating the 
age requirement. Under such circumstances, 
a 15 per cent or 20 per cent social security 
payroll tax would not be too far off, he said. 
"We believe it is unsound to assume that 
revenue possibilities from a payroll tax are 
limitless." 

Dr. Leonard W. Larson, president-elect 
of the American Medical Association, told 
the Committee the House bill is the "anti- 
thesis of the centralized, socialized, statist 
approach of the proposals advocating na- 
tional compulsory health insurance." 

A spokesman for the insurance industry 
pointed out "giant strides" made by private 
health insurance in recent years in cover- 
ing aged persons. E. J. Faulkner declared 
that one of the most prevalent and erron- 
eous assumptions on the matter is that 
most of the aged aren't able to contribute 
to financing their own health care costs. 

The Social Security health bills, he said, 
"would impair or destroy the private prac- 
tice of medicine, would add immeasurably 
to our already crushing tax burden, would 
aggravate our severe public fiscal problems, 
and would entail other undesirable conse- 
quences." 

In other testimony, the AFL-CIO again 
urged enactment of a Social Security health 
bill ; the American Optometric Association 
and the International Chiropractors Asso- 
ciation urged that health benefits included 
in any bill include the services of osteo- 
paths and chiropractors, respectively. 

On another legislative proposal of in- 
terest to the medical profession — the 
Keogh-Simpson bill — a Senate debate was 



scheduled this month. Senator Gordon Al- 
lott (R., Colo.) said in a Senate speech 
that "I believe that this legislation will 
have the overwhelming support of this 
body." 

The bill, which would encourage retire- 
ment savings by the self-employed such as 
lawyers, small businessmen and physicians 
has already been approved by the House. 
The Senate bill, voted by the Senate Fi- 
nance Committee, would require participat- 
ing self-employed to establish retirement 
plans for their employees. 



Jin fiemmiam 

Robert A. Matheson, M.D. 

Dr. Robert A. Matheson was born in Hoke 
County on January 12, 1898. He died at his home 
in Raeford, on April 24, 1960. 

He was graduated from the University of North 
Carolina. After studying medicine there for two 
years he enrolled at Jefferson Medical College 
where he was graduated in 1926. He served his in- 
ternship in Atlantic City, New Jersey, and was 
chief resident physician there for one year. He 
served in France during World War I and later 
was a major in the North Carolina National Guard. 
He was a member of the Raeford Methodist 
Church, the Raeford Kiwanis Club, and was a 
Shriner. 

He was a member of the Hoke County Medical 
Society, the Medical Society of the State of North 
Carolina, and the Southern Medical Association. 
He practiced medicine in Raeford from 1928 until 
his death. He was a family doctor in every sense 
of the word. He not only was friend, counselor and 
guide to his many patients, but was also highly 
esteemed by all his colleagues. 




Winston-Salem • 

• ••••□ a Greensboro 

*• •• * • 

• * •□ Raleigh 

•• •• 

gAsheville Washington. 




MATERNAL DEATHS REPORTED IN NORTH CAROLINA 
SINCE JANUARY I, I960 

Each dot represents one death 






August, 1960 



ADVERTISEMENTS 



XXIX 






ALDACTONE 



® 



IN EDEMA 

Because it acts by regulating a basic physiologic imbalance, 
Aldactone possesses multiple therapeutic advantages in treating 
edema. 

Aldactone inactivates a crucial mechanism producing and 
maintaining edema — the effect of excessive activity of the 
potent salt-retaining hormone, aldosterone. This corrective ac- 
tion produces a satisfactory relief of edema even in conditions 
wholly or partially refractory to other drugs. 

Also, Aldactone acts in a different manner and at a different 
site in the renal tubules than other drugs. This difference in 
action permits a true synergism with mercurial and thiazide 
diuretics, supplementing and potentiating their beneficial 
effects. 

Further, Aldactone minimizes the electrolyte upheaval often 
caused by mercurial and thiazide compounds. 

The accompanying graph shows a dramatic but by no means 
unusual instance of the effect of Aldactone in refractory edema. 

The usual adult dosage of Aldactone, brand of spironolactone, 
is 400 rag. daily. Complete dosage information is contained in 
Searle New Product Brochure No. 52. 

SUPPLIED: Aldactone is supplied as compression-coated 
yellow tablets of 100 mg. 

G.D. SEARLE & CO., Chicago 80, Illinois. 
Research in the Service of Medicine. 



weight- lbs ffi rs i S , Congestive Heart Failure 




140- 
130- 
120- 
110- 


























































































f 




















































































































1 


40 


A 

Or 


da 
ng 


do 

n 


ne 
4h 


rs. 




















































































































\ 


Vs. 


«. 


x 


\ 


\ 














severe actdo 


sis 












































aeetaioleamide 
250 mg./O.O.D. 














































V 


\ 


\ 








KCI 3gm./24h.s. [ 




i 


ysine HCI 30 gm./24 


rs. 


NH.CI 6gm/24hrs. prednisone 10 mg/24 hrs. 










hydrochlorothiazide 100 mg./24 hrs. *%+ 






maintained on digitalis 


l iTl 


1 








Ng 
1 


1 J J III III || 


5 10 15 20 25 30 35 40 45 50 55 58 

(Days on Tr eatment] 'patient discharged. weight normas 


day':, 



XXX 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 




August, 1960 



ADVERTISEMENTS 



XXXI 



whenever digitalis 
is indicated 



— g 



y 



LANOXIN DIGOXIN 



formerly known as Digoxin 'B. W. & Co. '" 



Boston, U«"= ^^^^^^— 



'LANOXIN' TABLETS 'LANOXIN' INJECTION 

0.25 mg. scored (white) 0.5 mg. in 2 cc. (I.M. or I.V.) 

0.5 mg. scored ( green ) 



'LANOXIN' ELIXIR PEDIATRIC 
0.05 mg. in 1 cc. 



BURROUGHS WELLCOME & CO. (U.S.A.) INC., Tuckahoe, N.Y. 



XXXII 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 






WHEN 
THE PATIE 
WITHO 
ORGANIC DISEASE 
COMPLAINS 



CONSIDER 



L NEOCHOLAN' 




Your patient will often respond promptly to Neocholan therapy. It greatly increases the flow of 
thin, nonviscid bile and corrects biliary stasis by flushing the biliary system. It also relaxes intesti- 
nal spasm, resulting in an unimpeded flow of bile and pancreatic juice into the small intestine. 
Neocholan helps to promote proper digestion and absorption of nutrients. It also encourages 
normal peristalsis by restoring intestinal tone. 



Each tabletprovides: Dehydrocholic Acid Compound, 
P-M Co. 265 mg. (Dehydrocholic Acid. 250 mg.); 
Homatropine methylbromide 1.2 mg.; Phenobarbital 
8.0 mg. Supplied in bottles of 100 tablets. 



MM 



PITMAN-MOORE COMPANY 

DIVISION OF ALLIED LABORATORIES, INC. 
INDIANAPOLIS, INDIANA 



August, 1960 



ADVERTISEMENTS 



XXXIII 




in all common diarrheas 



POMALIN 



LIQUID 



AN T I D I AR R H EAL 

with pleasant raspberry flavor 

V * 

— eases and speeds the return 
to normal bowel function — 

The comprehensive antidiarrheal formula of Pomalin brings positive relief to 
patients with specific and nonspecific diarrheas, bacillary dysentery, non- 
specific ulcerative colitis and enteric disturbances induced by antibiotics. 

Pectin and kaolin protect against mechanical irritation, adsorb toxins and 
bacteria, and consolidate fluid stools. Sulfaguanidine concentrates antibac- 
terial action in the enteric tract. Opium tincture suppresses excessive peristalsis 
and reduces the defecation reflex. 

Each palatable IS cc. ftab/espoon/ contains: 

Sulfaguanidine U.S. P. 2 Gm. 

Pectin N.F. 0.225 Gm. 

Kaolin 3 Gm. 

Opium tincture U.S. P. 0.08 cc. 

(equivalent to 2 cc. of paregoric) 
Dosage 

ADULTS: Initially 1 or 2 tablespoons 
from four to six times daily, or 1 or 2 
teaspoons after each loose bowel move- 
ment; reduce dosage as diarrhea sub- 
sides. 



I lltiitmob 

L LABORATORIES 

New York 18, . 



CHILDREN: Vi teaspoon (2.5 cc.) per 15 
pounds of body weight every four hours 
day and night until stools are reduced 
to five daily, then every eight hours for 
three days. 



HOW SUPPLIED: Bottles of 16 fl. oz 



Exempt narcotic. 

Available on prescription only. 




XXXIV 



NORTH CAROLINA MEDICAL JOURNAL 



August, I960 



for more normal living 
in angina pectoris 




Brand of Penlaerythrltol Tetranitrate, 30 mg. 



Antora-B 

with 50 mg. Secobarbital 

/ 



Reduces incidence and 
Severity of attacks 

Continuous release Antora cap- 
sules give long, sustained therapeutic 
effect that reduces the number and 
severity of attacks, lowers nitro-glyc- 
erin requirements. 

With reduced fear of attack your pa- 
tient Is encouraged to participate in 
activities to his allowed capacity. 




.:.. ? - 



P^ed&Um 






ANTORA or AISTORA-B 

One continuous release capsule 
before breakfast and one before 
the evening meal provides 24- 
hour prophylactic effect. 

Available in bottles of 60 and 
250 capsules. 



Effects sftlaiion 

without mvntal or 

phi/sival shur down 






• A low dosage of 
Secobarbital is grad- 
ually released with 
Antora over a 10-12- 
hour period to reduce 
the anxiety complex. 
Antora-B also minimizes 
insomnia due to pain 
and shortness of 
breath on effort. 



Mayrand m 



e. 



PHARMACEUTICALS 



Greensboro, North Carolina 



August, 1960 



ADVERTISEMENTS 



XXXV 







-,;. 



■ -.3- 



'**££%?& 










** 



. , 



■ i 



. 



; 



for dryness and itching, prickly heat and rash 
intertrigo, insect bites, other summer skin discomforts 




«M 



in the 



^bath 



6 



p=o 




^(N? 



SARDO acts promptly to help restore needed 
natural oil and moisture' to dry, itchy skin, by 
helping to re-establish the normal lipid-aque- 
ous balance. Thus SARDO eases irritation, 
soothes, softens, brings sustained comfort. 

USED IN THE BATH, SARDO releases millions 
of microfine water-dispersible globules* to pro- 
vide an emollient suspension which enhances 
your other therapy ... in prickly heat, intertrigo, 



insect bites, skin dryness and itch of atopic der- 
matitis, eczematoid dermatitis, senile pruritus, 
soap dermatitis, etc.' 

Patients appreciate pleasant, convenient, easy- 
to-use SARDO. Non-sensitizing. Most economical. 
Bottles of 4, 8 and 16 oz. 

Write for Lompm and literature . . . 

IjClT'ClBClU, ITIC. New York 22, New York 
e 1959 'Patent Pending. T. M. 



XXXVI 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 




Sterazolidin 

brand of prednisone-phenylbutazone 



Even in the more transient rheumatic 
disorders, an anti-inflammatory effect 
more potent than that provided by aspirin 
is often desirable to hasten recovery 
and get the patient back to work. 
By combining the anti-inflammatory 
action of prednisone and phenylbutazone, 
Sterazolidin brings about exceptionally 
rapid resolution of inflammation with relief 
of symptoms and restoration of function. 
Since Sterazolidin is effective in low 
dosage, the possibility of significant 
hypercortisonism, even in long-term 
therapy, is substantially reduced. 



Availability: Each Sterazolidin* capsule contains prednisone 
1.25 mg.; Butatolidin®, brand of phenylbutazone, 50 mg.; 
dried aluminum hydroxide gel 100 mg.; magnesium 
trisilicate 150 mg.; and homatropine methylbromlde 1.25 mg. 
Bottles of 100 capsules. 

Geigy. Ardsley, New York 



Geigy 



August, 1960 



ADVERTISEMENTS 



XXXVII 



Diagnostic 

Quandaries 

Colitis? Gall Bladder Disease? 

Chronic Appendicitis? 

Rheumatoid Arthritis ? Regional Enteritis ? 




I DISEASE that is frequently 
W A V overlooked in solving diag- 
W tfk ^ nostic quandaries is amebiasis. 
MH Its symptoms art' varied and 
contradictory, and diagnosis is extremely 
difficult. In one study, 56% of the cases 
would have been overlooked if the routine 
three stool specimens had been relied on. 1 

Another study found 96% of a group 
of 150 patients with rheumatoid arthritis 
were infected by E. histolytica. In 15 of 
these subjects, nine stool specimens were 
required to establish the diagnosis. 2 

Webster discovered amebic infection in 
147 cases with prior diagnoses of spastic 
colon, psychoneurosis, gall bladder dis- 
ease, nervous indigestion, chronic appen- 
dicitis, and other diseases. Duration of 
symptoms varied from one week to over 
30 years. In some cases, it took as many 
as six stool specimens to establish the 
diagnosis of amebiasis. 3 

Now treatment with Glarubin provides 
a means of differential diagnosis in sus- 
pected cases of amebiasis. Glarubin, a 
crystalline glycoside obtained from the 
fruit of Simarouba glauca, is a safe, effec- 
tive amebicide. It contains no arsenic, 
bismuth, or iodine. Its virtual freedom 
from toxicity makes it practical to treat 



suspected cases without undertaking dif- 
ficult, and frequently undependable, stool 
analyses. Marked improvement following 
administration of Glarubin indicates path- 
ologically significant amebic infection. 

Glarubin is administered orally in tablet 
form and does not require strict medical 
supervision or hospitalization. Extensive 
clinical trials prove it highly effective in 
intestinal amebiasis. 



* 



Glarubin 

TABLETS 

specific for intestinal amebiasis 

Supplied in bottles of 40 tablets, each 
tablet containing 50 mg. of glaucarubin. 

Write for descriptive literature, bibli- 
ography, and dosage schedules. 

1. Cook, J.E.. Briegs. G.W., and Hlndley, F.W.: Chronic Ame- 
biasis and the Need for a Diagnostic Profile, Am. Pract. and Dig 
ot Treat. 6:1S21 iDec, 1955). 

2 Rinehart. R.E.. and Marcus. H.: Incidence of Amebiasis in 
Healthy Individuals, Clinic Patients and Those with Rheumatoid 
Arthritis. Northwest Med.. 54:70S tJuly. 1955). 

3. "Webster. B.H.: Amebiasis, a Disease of Multiple Manifesta- 
tions, Am. Pract. and Dig. or Treat. 9:S97 (June, 195S). 

•U.S. Pat. Ne. 2,864,745 

THES.E. |V|ASSENGILL COMPANY 



NEW YORK 



BRISTOL, TENNESSEE 
KANSAS CITY 



SAN FRANCISCO 



XXXVIII 



NORTH CAROLINA MEDICAL JOURNAL 



August, I960 



• increases bile 
Dechotyl stimulates 
the flow of bile — 
a natural bowel 
regulator 




• improves motility 

Dechotyl gently stimulates 

intestinal peristalsis 



• softens feces 
""" Dechotyl expedites fluid 
penetration into bowel contents 



helps free your patient from both... 
constipation and laxatives 

DECHOTYL 

TR ABLETS' 

well tolerated... gentle transition to normal bowel function 

O Recommended to help convert the patient — naturally and gradually -to healthy 
bowel habits. Regimens of one week or more are suggested to assure mainte- 
nance of normal rhythm and to avoid the repetition of either laxative abuse or 
constipation. 

Average adult dose: Two Trablets at bedtime as needed or as directed by a physician. ^^^^^"' 
Action usually is gradual, and some patients may need 1 or 2 Trablets 3 or 4 times daily. AMES 

COMPANY, INC 

Contraindications: Biliary tract obstruction; acute hepatitis. £"■►""> ■ i"*«"« 

J t Toronto 'Canada 

Dechotyl Trablets provide 200 mg. Decholin,^ (dehydrocholic acid, Ames), 50 mg. 
desoxycholic acid, and 50 mg. dioctyl sodium sulfosuccinate, in each trapezoid-shaped. 
yellow Trablet. Bottles of 100. 
•Ames t.m. for trapezoid-shaped tablet. e<ieo 




August, 1960 



ADVERTISEMENTS 



XXXIX 



How to be 
Carefree 
Without 
Hardly 
Trying • • • 




It really takes a load off your mind. . . 
to know that you are protected from 
loss of income due to illness or accident! 

"Dr. Carefree" has no 30-day 
sick leave ... no Workmen's 
Compensation . . . BUT he has a 
modern emergency INCOME PROTEC- 
TION PLAN with Mutual of Omaha. 

When he is totally disabled by accident or sickness covered by this plan, this plan 
will give him emergency income, free of Federal income tax, eliminating the night- 
mare caused by a long disability. 

Thousands of members of the Medical Profession are protected with Mutual of Oma- 
ha's PROFESSIONAL MEN'S PLAN, especially designed to meet the needs of the 
profession. 

If you do not already own a Mutual of Omaha INCOME PROTECTION PLAN, get in 
touch now with the nearest General Agent, listed below. You'll get full details, with- 
out obligation. 



Mutuah 

OF OMAH 




Largest Exclusive Health and Accident Company in the World. 



G. A. RICHARDSON, General Agent 
Winston-Salem, N. C. 



J. A. MORAN, General Agent 
Wilmington, N. C. 



J. P. GILES, General Agent 
Asheville, N. C. 



XL 



NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 




1 



•^mJ 



no irritating crystals • uniform concentration in each drop 
STERILE OPHTHALMIC SOLUTION 

NEO HYDELTRASOL 



2,000 TIMES MORE SOLUBLE THAN 

"The solution of prednisolone has the 

advantage over the suspension in that no 

crystalline residue is left in the patient's 

cul-de-sac or in his lashes .... The other 

advantage is that the patient does not have to 

shake the drops and is therefore sure of 

receiving a consistent dosage in each drop." 2 



PREDNISOLONE 21 PHOSPHATE-NEOMYCIN SULEATE 

PREDNISOLONE OR HYDROCORTISONE 

1. Lippmann. : Arch. Ophth. 57:339. March 1957. 

2. Gordon, DM.: Am J. Ophth. 46:740, November 1958. 
supplied: 0.5% Sterile Ophthalmic Solution NEO- 
HYDELTRASOL (with neomycin sulfate) and 0.5% Sterile 
Ophthalmic Solution HYDELTRASOL'. In 5 cc. and 2.5 cc 
dropper vials. Also available as 0.25% Ophthalmic 
Ointment NEO-HYDELTRASOL (with neomycin sulfate) 
and 0.25% Ophthalmic Ointment HYDELTRASOL. 
In 3.5 Gm. tubes. 



HYDELTRASOL and NEO-HYDELTRASOL are trademarks of Merck S Co.. Inc. 
WSW MERCK SHARP & DOHMf Division of Merck S Co. Inc Philadelphia 1, Pa. 



August, 1960 



ADVERTISEMENTS 



XLI 



For Your Personal Pension Plan 

The special features of the New England Life 
contract will serve you to advantage 

Recently we have run ads in this Journal and pointed out the new privileges to be 
available to you and other professional practitioners in the formation of individual 
retirement programs. We described the flexible change of plan clause in our policies, 
and the special techniques and contracts developed in connection with Corporate 
Pension Plans, pointing out that those fearures and services could well be applicable 
to you personally. 

The experience and services of our Company and Agency are available to you in con- 
nection with your personal life insurance and retirement programs, regardless of 
and independent of the Smothers, Keogh-Simpson Legislation that may be passed. 
Any retirement program you may now initiate through New England Life can be 
adapted through such legislation as may be passed in the future. 

Again we list below our Agency Associates whose knowledge and experience may 
serve you well. 

AGENCY ASSOCIATES 



ASHEVILLE 

Henry E. Colton, C.L.U. 

CHARLOTTE 

A. J. Beall 
Richard Cowhig 
Colbert L. Dings 
T. Ed Thorsen, C.L.U. 

DURHAM 

R. Kennon Taylor, Jr., C.L.U. 

GASTONIA 

Hugh F. Bryant 

GREENSBORO 

J. Meredith Moore 



HICKORY 

O. Reid Lineberger 

HIGH POINT 

Walter M. Bullock 
George P. Clark 

RALEIGH 

John Cates 

Ryland Duke 

Carlyle Morris 

Reid S. Towler, C.L.U. 



REIDSVILLE 

James E. Everette 

STATESVILLE 

Tom White 
WILMINGTON 

Meares Harriss, L. L.U. 
Alex Urquhart, C.L.U. 

WILSON 

B. B. Plyler, Jr., C.L.U. 
WINSTON-SALEM 

Kenneth W. Maust 



ARCHIE CARROLL, C.L.U., GENERAL AGENT 



NEW ENGLAND 

C^fe/LIFE±f^fe 



«HI COMPANY THAI PCHJN040 MUTUAb IU>I IN|U«*"CI >" A M I * i CA - 



612 Wachovia Bank Building 



Charlotte, N. C. 



XLII 



NORTH CAROLINA MEDICAL JOURNAL 



August. 



SAINT ALBANS 

PSYCHIATRIC HOSPITAL 

(A Non-Profit Organization) 

Rad&ord, Virginia 


James P. 
Daniel D. Chiles, M. D. 

Clinical Director 
James K. Morrow, M. D. 
Silas R. Beany, M. D. 


STAFF 

<ing, M. D., Director 

William D. Keck, M. D. 
Edward W. Gamble, III, M. D. 
J. William Giesen, M. D. 
Internist (Consultant) 


Clinical Psychology: Don Phillips 
Thomas C. Camp, Ph. D. Administrator 
Artie L. Sturgeon, Ph. D. 

AFFILIATED CLINICS 
Bluefield Mental Health Center Beckley Mental Health Center 

525 Bland St., Bluefield, W. Va. 109 E. Main Street, Beckley, W. Va. 
David M. Wayne, M. D. W. E. Wilkinson, M. D. 
Phone: DAvenport 5-9159 Phone: CLifford 3-8397 
Charleston Mental Health Center Norton Mental Health Clinic 

1119 Virginia St., E., Charleston, W. Va. Norton Community Hospital, Norton, Va. 
B. B. Young, M. D. Pierce D. Nelson, M. D. 
Phone: Dickens 6-7691 Phone: 218, Ext. 55 and 56 



TUCKER HOSPITAL, Inc. 

212 West Franklin Street 
Richmond, Virginia 

A private hospital for diagnosis and treatment of psychiatric and neurol- 
ogical patients. 
Hospital and out-patient services. 

(Organic diseases of the nervous system, psychoneuroses, psychosomatic 
disorders, mood disturbances, social adjustment problems, involutional 
reactions and selective psychotic and alcoholic problems.) 



Dk. James Asa Shield 



Dr. Weir M. Tucker 



Dr. George S. Fultz 



Dr. Amelia G. Wood 



August, 1960 



ADVERTISEMENTS 



XLIII 



anorectic-ataractic 



BAMA 




meprobamate 400 mg.. with d-amphetamine sulfate 5 mg., Tablets 

FOR THERAPY 
. OF OVERWEIGHT PATIENTS 

■ d-amphetamine depresses appetite and 

elevates mood 

. i 

[."-•meprobamate eases tensions of dieting ! 

i (yet without overstimulation, insomnia or ' 

barbiturate hangover). 

I 

Dosage: One tablet one-half to one hour before each meal. | 

A LOGICAL COMBINATION 



APPETITE CONTROL 



L. , --- 



Patronize 



Your 



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AMERICA'S 

AUTHENTIC 

HEALTH MAGAZINE 



a good buy in 
public relations 

. . . place 

today's health 

in your reception room 

Give your order to a member of your local Medical 
Auxiliary or mail it to the Chicago office. 



SPECIAL 

HALF-PRICE RATES FOR 

PHYSICIANS, 

MEDICAL STUDENTS. INTERNS 



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PUBLISHED MONTHLY BY THE 
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XLIV 



NORTH CAROLINA MEDICAL JOURNAL 



August, 19(30 



HIGHLAND HOSPITAL, INC. 

Founded In 1904 

ASHEVILLE, NORTH CAROLINA 

Affiliated with Duke University 




A non-profit psychiatric institution, offering modern diagnostic and treatment procedures — insulin, electroshock, psy- 
chotherapy, occupational and recreational therapy — for nervous and mental disorders. 

The Hospital is located in a 75-acre park, amid the scenic beauties of the Smoky Mountain Range of Western North 
Carolina, affording exceptional opportunity for physical and emotional rehabilitation. 

The OUT-PATIENT CLINIC offers diagnostic service and therapeutic treatment for selected case desiring non- 
resident care. 

R. CHARMAN CARROLL, M.D. ROBERT L. CRAIG, M.D. JOHN D. PATTON, M.D. 
Medical Director Associate Medical Director Clinical Director 



Compliments of 

WachtePs, Inc* 

SURGICAL 
SUPPLIES 



65 Haywood Street 
ASHEVILLE, North Carolina 

P. O. Box 1716 Telephone 3-7616—3-7617 




p 

^logical 
-combination 
I for appetite 
| suppression 




s meprobamate plus 

i d-amphetamine... suppresses 




appetite. 



elevates mood.. 
without 



% reduces tension 
t v -; insomnia, overstimulation 
*~ Je or barbiturate hangover. 

anorectic-ataractic 
Dosage: One tablet one-half to one hour before each meal. 



August, 1960 



ADVERTISEMENTS 



XLV 



APPALACHIAN HALL 

ESTABLISHED — 1916 



ASHEVILLE 



NORTH CAROLINA 




An Institution for the diagnosis and treatment of Psychiatric and Neurological illnesses, rest, convalescence, drucr 

and alcohol habituation. 

Insulin Coma, Electroshock and Psychotherapy are employed. The Institution is equipped with complete laboratory 

facilities including electroencephalography and X-ray. 

Appalachian Hall is located in Asheville, North Carolina, a resort town, wnich justly claims an all around climate 

for health and comfort. There are ample facilities for classification of patients, rooms single or en suite. 



Wm. Ray Griffin, Jr., M.D. 
Robert A. Griffin, M.D. 



Mark A. Griffin, Sr., M.D. 
Mark A. Griffin, Jr., M.D. 



For rates and further information write APPALACHIAN HALL, ASHEVILLE, N. C. 



BRAWNER'S SANITARIUM, INC, 

(Established 1910) 
2932 South Atlanta Road, Smyrna, Georgia 



FOR THE TREATMENT OF PSYCHIATRIC ILLNESSES 
AND PROBLEMS OF ADDICTION 

MODERN FACI LITI ES 

Approved by Central Inspection Board of American Psychiatric Association 
and the Joint Committee on Accreditation 

Jas. N. Brawner, Jr., M.D. 
Medical Director 

Phone H Em lock 5-4486 



How to Turn a *5M Raise 
into a ^1,000 Bonus 



Wishing won't turn a $5 a week 
raise into a $1,000 bonus, but it's 
easy to do. If you take that $5 
raise and put it into U. S. Savings 
Bonds you can buy a $25.00 Bond 
a month (cost $18.75) and have 
money left over. If you keep buy- 
ing one of these Bonds a month 
for 40 months you'll have your 



big bonus— Bonds worth $1,000 
at maturity. 

It's a pretty smart idea to save 
a raise. It's money you didn't 
have before and shouldn't miss. 
But, whether you've just gotten a 
raise, or not, why don't you ask 
your employer to include you in 
the Payroll Savings Plan? 



Why U.S. Savings Bonds are such 
good way to save. 

• You can save automatically wi 
the Payroll Savings Plan • Y< 
now earn 3 :! 4 ' c interest to m 
turity • You invest without ri 
under U. S. Government guara 
tee • Your money can't be lo 
or stolen • You can get yo 
money, with interest, anytime yi 
want it • You save more thi 
money; you help your Governme 
pay for peace • You can bi 
Bonds where you work or ban 





EVEN IF YOUR 

BONDS ARE 

DESTROYED. YOUR 

MONEY IS SAFE. 

Your Bonds 
are recorded 
in your name 
at the Treas- 
ury. If any- 
thing happens to them the Gov- 
ernment replaces them free. 




YOU SAVE MORE THAN MONEY. You help save 
the things worth living for. Every Bond 
dollar helps keep America strong to pre- 
serve the peace. 



Every Savings Bond you own — old 
or new — earns ^ % more than ever 
before when held to maturity. 



You Save More 
Than Money With 
U.S. Savings Bonds 



WHAT SHOULD HE DO WITH AN EXTRA S5 A WEEK? He can spend it, of 
course. But, if he buys a $25.00 U. S. Savings Bond each 
month for 40 months with his $5 a week raise, he is going 
to have Bonds worth $1,000. 



The U. S, Government does not pay for this 
advertising. The Treasury Department thanks 
The Advertising Council and this magazine 
for their patriotic donation. 






August, 1960 



ADVERTISEMENTS 



XLVII 



r 1 

A ! 

logical 

prescription for 

overweight patients 



anorectic-ataractic 





■ m m m I 

j meprobamate 400 mg., with d-amphetamine sulfate 5 mg., Tablets 
i 

meprobamate plus d-amphetamine... 
depresses appetite... elevates mood... 
eases tensions ot dieting. ..without over- 
stimulation, insomnia or barbiturate 

hangover. 
\ 

Dosage: One tablet one-half to one hour before each meal. 




Come to Mr. Pisgah and be tranquillized 
by nature. Rustic inn & cottages perched 
high on slope in National Forest near 
Asheville. Heavenly quiet. Cool. Over- 
looks glorious Great South View. Exhil- 
arating air, superb food. Refuge and 
restorative for tired doctors. May 1-Oct. 
31. 



Write 

PISGAH FOREST INN 

Candler, N. C. Rr. 1, Box 433 




Posture 



is A PLUS 



YOU CAN GET FROM SLEEPING ... 
THAT'S WHY IT'S WISE TO SLEEP ON A 

Sealq 

POSTUREPEDIC 



Uniformly firm, 
Sealy Posture pedic 
keeps the spine 
level. Healthfully 
comfortable, it per- 
mits proper relaxa- 
tion of musculatory 
system and limbs. 
Exclusive "live-ac- 
tion" coils support 
curved, fleshy con- 
tours of the body, 
assuring relaxing 
rest that you know 
is basic to good 
health . . . and good 
posture. 




A Sagging 
Mattress Can 
Cause This) 



PROFESSIONAL 

DISCOUNT 
OF 



$39 



00 



Limit of one full or 
two twin size sets 

Please check preference 



So that you as a physician can 
judge the distinctive features of the 
Sealy Posture pedic mattress for 
yourself before you recommend it 
to your patients, Sealy offers a spe- 
cial Doctor's Discount on this mat- 
tress and foundation, when pur- 
chased for your personal use. 



SEALY MATTRESS COMPANY 

666 Lake Shore Drive, Chicago 1 1 , Illinois 
RETAIL 
Posturepedic Mattress each $79.50 



Posturepedic Foundation each $79.50 

TTull size ( ) 1 Twin size ( ) 2 
Enclosed is my check and letterhead. 
Please send my Sealy Posture pedic Set(s) to. 



PROFESSIONAL 

add 5 ratel $°0.00 
,ax ( $60.00 

Twin size { ) 



ADDRESS. 

~ity 



_ZONE_ 



XLVIII 



NORTH CAROLINA MEDICAL JOURNAL 



August, I960 



m iialis 

in its completeness 




ira rro i' 
Digitalis 

I D* v \r a Ren- I 

O.l Gram 

aipiox. I 1 -. 8r »inst 
CAUTIQKi FvdereJ 
law prohibit* dispens- 
ing without pr«**(*rip- 
tion 




Each pill is 

equivalent to 

one USP Digitalis Unit 

Physiologically Standardized 

therefore always 

dependable. 



Clinical samples sent to 
physicians upon request. 



Da vies, Rose & Co., Ltd. 
Boston, 18, Mass. 





*! Convalescence 



a 



Adolescence 




Infant diarrhe^ 




Debilitating 

gastrointestinal 

conditio! 



Old age 



Whenever 
the diet is faulty, 
the appetite poor, 
or the loss of food 
is excessive 

through vomiting 
or diarrhea — 

Valentine's 

MEAT EXTRACT 



stimulates the appetite, 

increases the flow of 
digestive juices, 

provides: supplementary 
amounts of vitamins, minerals 
and soluble proteins, 

extra-dietary vitamin B u , 

protective quantities of 
potassium, in a palatable and 
readily assimilated form. 



• Postoperatively 




Supplied in bottles oj 2 or 6 jluidounces. 

Dosage is 1 teaspoonjul two or three times 
daily; two or three times this amount for 
potassium therapy. 

VALENTINE Company, Inc. 

RICHMOND 21, VIRGINIA 



August, 1960 



ADVERTISEMENTS 



MUX 




Westbrook. Sanatorium ]— , 



RICHMOND 



€stablisheJ iQlL 



VIRGINIA 



A. private psychiatric hospital em- 
ploying modern diagnostic and treat- 
ment procedures — electro shock, in- 
sulin, psychotherapy, occupational 
and recreational therapy — for nervous 
and mental disorders and problems of 
addiction. 



Staff Pu '- v - ANDERSON, M.D., President 

REX BLANKINSHIP, M.D., Medical Director 

JOHN R. SAUNDERS, M.D., Assistant 
Medical Director 

THOMAS F. COATES, M.D., Associate 

JAMES K. HALL, JR., M.D., Associate 

CHARLES A. PEACHEE, JR., M.S., Clinical 
Psychologist 

R. H. CRYTZER, Administrator 



Brochure of Literature and Views Sent On Request - P. O. Box 1514 • Phone 5-3245 





Protection Against Loss of Income 
from Accident & Sickness as Well as 
Hospital Expense Benefits for You and 
All Your Eligible Dependents 



All 



PREMIUMS 



COME FIOM 



PHYSICIANS 
SURGEONS 
DENTISTS 



All 



BENEFITS 



GO TO 



PHYSICIANS CASUALTY & HEALTH 
ASSOCIATIONS 

OMAHA 31, NEBRASKA 
Since 1902 

Jandsome Professional Appointment Book sent to 
yon FREE upon request. 



F " • ■ : 

i A LOGICAL ADJUNCT TO THE | 
WEIGHT-REDUCING REGIMEN 



meprobamate plus d-amphetamine . . . 

reduces appetite. ..elevates mood. ..eases 

tensions of dieting,.. without overstimula- j 

i tion, insomnia or barbiturate hangover. 
I I 

Dosage: One tablet one-half to one hour before each meal. . 



anorectic-ataractic 




NORTH CAROLINA MEDICAL JOURNAL 



August, 1960 



THIS 




Doctor 



IS the SYMBOL 0F ASSURANCE OF ETHICAL 
public relations minded handling of your accounts 
receivable and collection problems. 



IS ,he EMBLEM of sound experience in SERVICE 
to the professional offices. 

IS ,he MARK of a complete PROFESSIONAL 
accounts receivable service. 



Here Are the BUREAUS in Your Area Capable and Ready to Serve You 



MEDICAL-DENTAL CREDIT BUREAU 
514 Nissen Building 
P. O. Box 3136 
Winston-Salem, N. C. 
Phone PArk 4-8373 

MEDICAL-DENTAL CREDIT BUREAU 
715 Odd Fellows Building 
Raleigh, N. C. 
Phone TEmple 2-2066 

MEDICAL-DENTAL CREDIT BUREAU 
513 Security Bank Building 
High Point, N. C. 
Phone 3955 

MEDICAL-DENTAL CREDIT BUREAU 
A division of Carolina Business Services 
Room 10 Masonic Temple Building 
P. O. Box 924 
Wilmington, N. C. 
Phone ROger 3-5191 



MEDICAL-DENTAL CREDIT BUREAU 
212 West Gaston Street 
Greensboro, N. C. 
Phone BRoadway 3-8255 

MEDICAL-DENTAL CREDIT BUREAU 
220 East 5th Street 
Lumberton, N. C. 
Phone REdfield 9-3283 

MEDICAL-DENTAL CREDIT BUREAU, 

225 Hawthorne Lane 

Hawthorne Medical Center 

Charlotte, N. C. 

Phone FRanklin 7-1527 

THE MEDICAL-DENTAL CREDIT BUREAU 
Westgate Regional Shopping Center 
Post Office Box 2868 
Asheville, North Carolina 
Phone ALpine 3-7378 



INC. 





j B 


BBtSVi 






























II ... 


. .1. 






" 


:"**•? 


I 




« 








L - ' 



i 



fi 



For Prevention and Reversal of 

Cardiac Arrest 

The Birtcher Mobile Cardiac Monitoring and Re- 
suscitation Center* 
\ 

Cardiac Arrest is an ever present danger during 
anesthesia 

Cardiac arrest can occur during an anesthesia, even to 
patients with no prior record of cardiac disease. Contin- 
uous monitoring of every patient can prevent most 
cardiac arrests by providing advance warning. For cases 
where the accident cannot be prevented, instruments to 
reverse the arrest and restore circulation should always 
be instantly available. 

'Comprised of the Birtcher Cardioscope, EEG Pre-Amplifier, Dual 
Trace Electronic Switch. Electrocardiograph. Defibrillator and Heart- 
pacer with all necessary attachments on a Mobile Stand as shown. 

Carolina Surgical Supply Company 

r m "The House of Friendly and Dependable Service" 

~ 706 TUCKER ST. TEL: TEMPLE 3-8631 

4~~7 RALEIGH. NORTH CAROLINA 



August, 1960 



ADVERTISEMENTS 



LI 



INDEX TO ADVERTISERS 



American Casualty Insurance Company XIX 

Ames Company XXXVIII 

Appalachian Hall XLV 

Arnar-Stone Laboratories XIII 

Brawner's Sanitarium XLV 

Brayten Pharmaceutical Company XV 

Bristol Laboratories XVIII, XXI 

Burroughs-Wellcome & Company XXXI 

Carolina Surgical Supply Co L 

Columbus Pharmacal Company XXX 

J. L. Crumpton XXVIII 

Davies, Rose & Co XLVIII 

Geigy Pharmaceutical XXXVI 

Highland Hospital XLIV 

Hospital Saving Assn. of N. C XXV 

Jones and Vaughan, Inc Ill 

Lederle Laboratories XXVI, XXVII, XLIII, 

XLIV, XLVII, XLIX 
Eli Lilly & Company XXVII, Front Cover 

The S. E. Massengill Company XXXVII 

Mayrand, Inc XXXIV 

Medical-Dental Credit Bureau L 

Merck, Sharp & Dohme Second Cover, XL 

Mutual of Omaha XXXIX 

New England Mutual Life Insurance Co XLI 

Parke, Davis & Co LII, Third Cover 



Physicians Casualty Association 

Physicians Health Association XLIX 

Physicians Products Company XII 

Pinebluff Sanitarium I 

Pisgah Forest Inn XLVII 

Pitman-Moore Company XXXII 

P. Lorillard Company (Kent Cigarettes) XI 

A. H. Robins Company X, XXIII 

J. B. Roerig & Company XXII 

Saint Albans Sanatorium XLII 

Sardeau, Inc XXXV 

W. B. Saunders Company VII 

Sealy of the Carolinas, Inc XLVII 

G. D. Searle & Co XXIX 

Smith-Kline & French Laboratories 4th Cover 

E. R. Squibbs and Sons XIV, XX 

St. Paul Fire and Marine Insurance LI 

Tucker Hospital XLII 

U. S. Vitamin Company Reading- 
Valentine Company XLVIII 

Wachtel's Incorporated XLIV 

Wallace Laboratories XVI, Insert, XVII 

Wesson Oil and Snowdrift 

Sales Company IV, V 

Westbrook Sanitorrum XLIX 

Winchester Surgical Supply Co. 

Winchester-Riteh Co I 

Winthrop Laboratories VI, Insert, IX, XXXIII 







•Ury 



CHOSEN BY MEDICAL 
SOCIETY OF THE STATE OF 
NORTH CAROLINA FOR 
PROFESSIONAL 
LIABILITY INSURANCE 



for your complete insurance needs . . . 

^PROFESSIONAL 
* PERSONAL 
ik PROPERTY 



THERE IS A SAINT PAUL AGENT IN YOUR 
COMMUNITY AS CLOSE AS YOUR PHONE 



Head Office 
412 Addison Building 
Charlotte, North Carolina 
EDison 2-1633 



HOME OFFICE: 385 WASHINGTON ST., ST. PAUL, MINN. 



SERVICE OFFICE: RALEIGH, NORTH CAROLINA— 323 W. MORGAN ST. TEmple 4-7458 



allergen in the wind 






when pollens harry the unwary 




antihistaminic-antispasmodic 



gives prompt, comprehensive relief 

In hay fever, BENADRYL provides simultaneous, 
dual control of allergic symptoms. Nasal congestion, 
lacrimation, sneezing, and related histamine reac- 
tions are effectively relieved by the antihistaminic 
action of BENADRYL. At the same time, its anti- 
spasmodic effect alleviates bronchial and gastro- 
intestinal spasms. This duality of action makes 
BENADRYL valuable throughout a wide range of 
allergic disorders. 

BENADRYL Hydrochloride (diphenhydramine hydrochloride, 
Parke-Davis) is available in a variety of forms including: Kap- 
seals,®' 50 mg. each; Kapseals, 50 mg„ with ephedrine sulfate, 
25 mg.; Capsules, 25 mg. each; Elixir, 10 mg. per 4 cc.; and for 
delayed action, Emplets,® 50 mg. each. For parenteral therapy, 
Benadryl Hydrochloride Steri-Vials,® 10 mg. per cc; and Am- 
poules, 50 mg. per cc. 



PARKE-DAVIS 



PARKE, DAVIS & COMPANY- DETROIT 32, MICHIGAN 





in overweight 



« 



DE 




A 



brand of dextro amphetam'ne and amobarbital 



brand of sustained release capsules 



® 



[— r:® 

j ~! 









SMITH 
KLINEOf 
FRENCH 



for the patient who is tense, 
irritable, frustrated by inability 
to stick to diet 



. . . and for the patient who is listless, 
lethargic, depressed by reducing regimens: 

R DEXEDRINE* SPANSULE® 

brand of dextro amphetamine brand ot sustained release capsules 

sulfate 

Each 'Dexamyl' Spansule sustained release capsule (No. 2) contains 'Dexedrlne' (brand of 
dextro amphetamine sulfate), 15 mg., and amobarbital, 1VS gr. Each 'Dexamyl' Spansule cap- 
sule (No. 1) contains 'Dexedrine', 10 mg., and amobarbital, 1 gr. 

Each 'Dexedrine' Spansule sustained release capsule contains dextro amphetamine sulfate, 
5 mg., 10 mg., or 15 mg. 



NORTH CAROLINA 




RECEIVED 

OCCUPATIONAL HEALTH ISSUE , on 

OCT 3 60 

Congress on Industrial Health — Charlotte, October 10-12 

DIVISION OF 

Jcc&iRS LIBRARY- 
HEALTH AFFAIRS lid 



.; 



when judgment dictates oral penicillin, experience dictates. 



V-CILLIN K 



(penicillin V potassium, Lilly) 



' for maximum effectiveness 
for unmatched speed 
for unsurpassed safety 

In tablets of 125 and 250 mg. 

ELI LILLY AND COMPANY • INDIANAPOLIS 6, INDIANA, U.S.A. 



® 



Sfay 






033230 







Table of Contents, Page II 



LINICAL REMISSION 

I A "PROBLEM" ARTHRITIC 

heumatoid arthritis with j erious_corticoid side effects. Follow.ng 
ound weight loss and acute g.i. distress on prednisolone, a 45-year- 
bookkeeper with a five-year history of severe arthritis was started 
)ecadron, 1 mg./day. Dosage was promptly reduced to 0.5 mg./day. 
,r ten months on Decadron, she gained back eleven pounds, feels 
1 well, and had no recurrence of stomach symptoms. She is in 
ical remission .* 

convenient b.i.d. aUernate dosage schedule: ,he degree and extent of relief provided b» 
IDRON atiows tor b.i.d. maintenance dosage in man, patients with so-called chrome .cor , ,- 
, Acute manifestations sbou.d first be brought under contro! w,th a t.,.d. or q.i.d. schedule, 
rttod- As 75 mg. and 0.5 mg. scored, pentagon-shaped tablets in bottles of 100. Also available 
Action DECADRON Phosphate. Addition, information on DECADRON is available t. phys.c.ans 
equest. DECADRON is a trademark of Merck & Co.. Inc. 
„ a clinical investigator's report to Merck Sharp & Dohme. 

lecadron 

REflfS MORE PATIENTS MORE EFFECTIVELY 

TM MERCK SHARP & DOHME • Division of Merck & Co., Inc., West Point, Pa. 








September, 1960 



ADVERTISEMENTS 




A Sanitarium for Rest Under Medical Supervision, and Treatment of Nervous 
and Mental Diseases, Alcoholism and Drug Addiction. 

The Pineulutf sanitarium is situated in the sandhills of North Carolina in a 60-acre park 
uf long pines. It is located on U. S. Route 1, six miles south of Pinehurst and Southern 
Pines. This section is unexcelled for its healthful climate. 

Ample facilities are afforded for recreational and occupational therapy, particularly out- 
of-doors. 

special stress is laid on psychotherapy. An effort is made to help the patient arrive at 
an understanding of his problems and by adjustment to his personality difficulties or 
modification of personality traits to effect a cure or improvement in the disease. Two resident 
physicians and a limited number of patients afford individual treatment in each case. 

Kor further information write: 

The Pineblu££ Sanitarium, PinebiuSS, N. c. 



iMalcolm D. Kemp, M.D. 



Medical Director 



ITTER*** the finest for 

the profession! 



Just a FEW of the Outstanding Features 



THE RITTER UNIVERSAL TABLE enables 
you to treat more patients more thoroughly, 
with less effort in less time. Here is the ulti- 
mate in examining table flexibility . . . easy 
to position . . . more comfortable for patients. 



• Grey vinyl upholstery, fabric backed. 

• Perineal cut-out and stainless irrigating pan. 

• Retractable, adjustable heel stirrups. 

• Combination proctologic kneerest, footrest and 
table extention. 

• Maximum Trendelenburg 42°, Maximum 
Reverse Trendelenburg 15°. 

• Full 18" elevation from low of 26' 2" to high 

of 44 y 2 ". 

• Effortless hand wheel tilt. 

• Motor base has foot pedal elevating and lowering 
controls accesible from either side of table. 

Silver metallic finish 

• Base permits 180° table rotation; foot lever rotation 
lock. 

• Stationary base plate, black enamel finish. 

Authorized agents for, RITTER, LIEBEL-FLARSHEIM and CASTLE 




WINCHESTER 



"CAHOLINAS' HOUSE OF SERVICE" 

WINCHESTER SURGIICAL SUPPLY CO. WINCHESTER-RITCH SURGICAL CO. 

421 West Smith St. Greensboro, N. C. 



119 East 7th Street 



Charlotte, N. C. 



II 



NORTH CAROLINA MEDICAL JOURNAL 



September. I960 



North Carolina Medical Journal 

Official Organ of 
The Medical Society of the State of North Carolina 



Volume 21 

Number 9 



September, 1960 



76 CENTS A COPY 
$6.00 A YEAR 



CONTENT 



Original Articles 

Meeting- North Carolina's Occupational Health 
Needs Through Our State Agencies — Emil 
T. Chamblett 357 

Economic Influences of an Industrial Medical 
Program on a Countv Society — Mac Ray 
Gasque, M.D., and Carl S. Plumb, M.D. . . 361 

Compensable Occupational Diseases Under the 
North Carolina Workmen's Compensation 
Act— J. W. Bean 365 

Radiation Hazards in Industry — Thomas S. 
Ely, M.D 367 

Physical Requirements in Textile Manufac- 
turing — Charles G. Gunn, Jr., M.D. . . . 371 

The Governor's Council on Occupational 
Health: A Medium of Cooperative Effort 
for the Health of the Worker — William 
P. Richardson, M.D 377 

Clinical Evaluation of the Antacid Properties 
of Hydrated Magnesium Aluminate — David 
Cayer, M.D., and M. Frank Sohmer, M.D. . 380 

Mail Order Prescription Services — H. C. Mc- 
Allister 382 

Editorials 

The National Election 385 

Sabin Live-Virus Polio Vaccine Approved . . 386 

Occupational Health Issue 387 

The Speeding Ambulance 387 

Mail Order Prescriptions 388 



Bulletin Board 

Coming Meetings 389 

New Members of the State Society .... 390 

News Notes from the Bowman Gray School 
of Medicine 391 

News Notes from the Duke University Med- 
ical Center "... 391 

News Notes from the University of North 

Carolina School of Medicine 391 

Winston-Salem Heart Symposium 392 

North Carolina Board of Medical Examiners . 393 

County Societies 393 

News Notes 393 

Announcements 394 

Book Reviews 

399 

In Memoriam 

401 

Auxiliary 

Transactions of the Thirty-seventh Annual 
Session 403 

Roster of Members, 1959-1960 413 

Classified Advertisements 

400 



President's Message 

388 



Index to Advertisers 
lxxi 



Entered as second-class matter January 2. 1940, at the Post Office at Winston-Salem. North Carolina, under the Act of 
August 24, 1912. Copyright 1960 by the Medical Society of the Stat* of North Carolina. 




if? 




® 




SYRUP OF CHLORAL HYDRATE 



NEW RALDRATE NOW SOLVES THE PROBLEM 
OF TASTE RESISTANCE TO CHLO RAL -HY DRATE 

10 Grains (U.S. P. Dose) of palatable lime flavored 
chloral-hy drate syrup in each teaspoonful 

RAPID SEDATION WITHOUT HANGOVER 



JONES and VAUGHAN, Inc. Richmond 26 



, VA. 



/w#r 



clinically proven efficacy 

in relieving tension . . . curbing hypermotility and excessive secretion in G. I. disorders 



A 


^ 


95% 






EXCEL 




TRIDIHEXETHYL 


85% 


LENT 


lODIDEt 
MEPROBAMATE 




TRIDIHEXETHYL 
lODIDEt 


GO 


ij ij&L v 






86 PATIENTS 21 PATIENTS 


i 


5% 




FA 


IR 


15% 


BWTl 


OR 









PATHIBAMATE combines two highly effective and 

well-tolerated therapeutic agents: 

Meprobamate— widely accepted tranquilizer 

and 
PATHILON tridihexethyl chloride— antichol- 
inergic noted for its effect on motility and 
gastrointestinal secretion with few unwanted 
side effects. 

Contraindications: glaucoma, pyloric obstruction, and 
obstruction of the urinary bladder neck. 



t 



METHANTHELINE 
BROMIDE 



1 ATROPINE SULFATE 



PLACEBO 



colic 



I 



'31 PATIENTS 



62 PATIENTS 103 PATIENTS 



Two available dosage strengths permit adjusting therap; 
to the G.I. disorder and degree of associated tension. 



I 



Where a minimal meprobamate effect is preferred . 

PATHIBAMATE-200 Tablets: 200 mg. of meprobamate; 
25 mg. of PATHILON 

Where a full meprobamate effect is preferred . . . 

PATHIBAMATE-400 Tablets: 400 mg. of meprobamate; 
25 mg. of PATHILON 

Dosage: Average oral adult dose is 1 tablet 
t.i.d. at mealtime and 2 tablets at bedtime. 



' 



Pathibamate 

meprobamate with PATHILON® tridihexethyl chloride Lederle 



400 
200 



fi 



clinically proven safety 



The efficacy of PATHIBAMATE has been confirmed Pictured are the results obtained with the PATHILON 

clinically in duodenal ulcer, gastric ulcer, intestinal (tridihexethyl iodide)-meprobamate combination! in a 

colic, spastic and irritable colon, ileitis, esophageal double-blind study of 303 ulcer patients, extending over 

spasm, anxiety neurosis with gastrointestinal symp- a period of 36 months.* They clearly demonstrate the 

toms, and gastric hypermotility. efficacyof PATHIBAMATE in controllingthesymptoms. 



SIDE EFFECTS 



DRY MOUTH 



TRIDIHEXETHYL 

lODIDEt 
MEPROBAMATE 




SAME OR MORE 



TRIDIHEXETHYL 
lODIDEt 



5% 



0% 



0% 



0% 



0% 



9% 



0% 



5% 



23% 



62% 



15% 



METHANTHELINE 
BROMIDE 



72% 



28% 



50% 



18% 



0% 



3% 



0% 



5% 



25% 



52% 



23% 



ATROPINE SULFATE 



46% 



14% 



34% 



11% 



0% 



9% 



6% 



14% 



17% 



37% 



46% 



PLACEBO 



5% 



0% 



1% 



1% 



0% 



10% 



0% 



2% 



26% 



24% 



50% 



*Atwater, J. S., and Carson, J. M.: Therapeutic Principles in Management of Peptic Ulcer. Am. J. Digest. Dis. 4:1055 (Dec.) 1959. 

fPATHILON is now supplied as tridihexethyl chloride Instead of the iodide, an advantage permitting wider use, since the latter could 
distort the results of certain thyroid function tests. 



y^£) LEDERLE LABORATORIES, A Division of AMERICAN CYANAMID COMPANY, Pearl River, New York 

control the tension - treat the trauma 



a new, improved, 
more potent relaxant 
for anxiety and tension 




effective in half the dosage required with meprobamate 

much less drowsiness than with meprobamate, 
phenothiazines, or the psychosedatives 

does not impair intellect, skilled performance, or normal behavior 

neither depression nor significant toxicity has been reported 



alert tranquillity 




EMYLCAMATE 



a familiar spectrum of antianxiety and muscle-relaxant activity 

no new or unusual effects— such as ataxia or excessive weight gain 

may be used in full therapeutic dosage even in geriatric or debilitated patients 

no cumulative effect 

simple, uncomplicated dosage, providing a wide margin of safety for office use 

STRIATRAN is indicated in anxiety and tension, occurring alone or in 

association with a variety of clinical conditions. 

Adult Dosage: One tablet three times daily, preferably just before meals. 

In insomnia due to emotional tension, an additional tablet at bedtime usually 

affords sufficient relaxation to permit natural sleep. 

Supply: 200 mg. tablets, coated pink, bottles of 100. 

While no absolute contraindications have been found for Striatran in full recommended dosage, 
the usual precautions and observations for new drugs are advised. 

For additional information, write Professional Services, 
Merck Sharp & Dohme. West Point, Pa. 

MERCK SHARP &. DOHME, division of merck &. co., inc.. west point, pa. 

STRIATRAN IS A TRADEMARK OF MERCK & CO., INC. 



VIII NORTH CAROLINA MEIHi'Al. J()li:XAI. September, l'.ici) 

Medical Society of the State of North Carolina 

OFFICERS — 1960 

President — Amos Neill Johnson, M.D., Garland 

President Elect — Claude B. Squires, M.D., 225 Hawthorne Lane, Charlotte 
Past President — John C. Reece, M.D., Grace Hospital, Morganton 
First Vice-President — Theodore S. Raiford, M.D., Doctors Building, Asheville 
Second Vice-President — Charles T. Wilkinson, M.D., Wake Forest 
Secretary — John S. Rhodes, M.D., 700 West Morgan Street, Raleigh 
Executive Director — Mr. James T. Barnes, 203 Capital Club Building, Raleigh 
The President, Secretary and Executive Director are members ex-officio 

of all committees 
Speaker-House of Delegates — Donald B. Koonce, M.D., 408 N. 11th St., Wilmington 
Vice-Speaker-House of Delegates — E. W. Schoenheit, M.D., 46 Haywood St., Asheville 



COUNCILORS — 1958 - 1961 

First District^-T. P. Brinn, M.D., 118 W. Market Street, Hertford 

Vice Councilor — Q. E. Cooke, M.D., Murfreesboro 
Second District — Lynwood E. Williams, M.D., Kinston Clinic, Kinston 

Vice Councilor — Ernest W. Larkin, Jr., M.D., 211 N. Market St., Washington 
Third District — Dewey H. Bridger, M.D., Bladenboro 

Vice Councilor — William A. Greene, M.D., 104 E. Commerce St., Whiteville 
Fourth District — Edgar T. Beddingfield, Jr., M.D., P.O. Box 137, Stantonsburg 

Vice Councilor — Donnie H. Jones, M.D., Box 67, Princeton 
Fifth District— Ralph B. Garrison, M.D., 222 N. Main Street, Hamlet 

Vice Councilor — Harold A. Peck, M.D., Moore County Hospital, Pinehurst 
Sixth District — George W. Paschal, Jr., M.D., 1110 Wake Forest Rd., Raleigh 

Vice Councilor — Rives W. Taylor, M.D., P.O. Box 1191, Oxford 
Seventh District — 

Vice Councilor— Edward S. Bivens, M.D., Stanly County Hospital, Albemarle 
Eighth District— Merle D. Bonner, M.D., 1023 N. Elm Street, Greensboro 

Vice Councilor — Harry L. Johnson, M.D., P.O. Box 530, Elkin 
Ninth District — Thomas Lynch Murphy, M.D., 116 Rutherford St., Salisbury 

Vice Councilor — Paul McNeely Deaton, M.D., 766 Hartness St., Statesville 
Tenth District — William A. Sams, M.D., Main Street, Marshall 

Vice Councilor — W. Otis Duck, M.D., Drawer 517, Mars Hill 

DELEGATES TO THE AMERICAN MEDICAL ASSOCIATION 

Elias S. Faison, M.D., 1012 Kings Drive, Charlotte 

C. F. Strosnider, M.D., 111 E. Chestnut Street, Goldsboro 

Millard D. Hill, M.D., 15 W. Hargett Street, Raleigh 

William F. Hollister, M.D., (Alternate), Pinehurst Surgical Clinic, Pinehurst 

Joseph F. McGowan, M.D., (Alternate), 29 Market Street, Asheville 

Wm. McN. Nicholson, M.D., (Alternate), Duke Hospital, Durham 

SECTION CHAIRMEN 1959-1960 

General Practice of Medicine — Julius Sader, M.D., 205 East Main Street, Brevard 
Internal Medicine — Walter Spaeth, M.D., 116 South Road, Elizabeth City 
Ophthalmology and Otolaryngology — Charles W. Tillett, Jr., M.D., 1511 Scott 

Avenue, Charlotte 
Surgery — James E. Davis, M.D., 1200 Broad Street, Durham 
Pediatrics — William W. Farley, M.D., 903 West Peace Street, Raleigh 
Obstetrics & Gynecology — H. Fleming Fuller, M.D., Kinston Clinic, Kinston 
Public Health and Education — ISA C. Grant, M.D., Box 949, Raleigh 
Neurology & Psychiatry — Myron G. Sandifer, M.D., N. C. Memorial Hospital, 

Chapel Hill 
Radiology — Isadore Meschan, M.D., Bowman Gray School of Medicine, 

Winston-Salem 
Pathology — Roger W. Morrison, M.D., 65 Sunset Parkway, Asheville 
Anesthesia — Charles E. Whitcher, M.D., Route 1, Pfafftown 
Orthopedics & Traumatology — Chalmers R. Carr, M.D., 1822 Brunswick Avenue, 

Charlotte 
Student AMA Chapters — Mr. John Feagin, Duke University School of Medicine. 

Durham 



September, 1960 



ADVERTISEMENTS 



IX 




YEARS 



senile 
anxiety 

disorientation 

agitation 

hostility 

irritability 

apprehension 

hysteria 

insomnia 

chronic 
urticaria 

alcoholism 

menopausal 
syndrome 

neuro- 
dermatoses 

functional 

gastrointestinal 

disorders 

psychoneuroses 

tension 

headaches 

dysmenorrhea 

psychosomatic 
complaints 

situational 
stress 

asthma 

hyperactivity 

tics 

preoperative 
anxiety 

enuresis 
behavior 
problems 



ATARAX ENCOMPASSES MORE PATIENT NEEDS... LETS YOU 
CHART A SAFER, MORE EFFECTIVE COURSE TO TRANQUILITY 



Atarax has a wide range of flexibility . . . from 
mild adult tensions and^anxieties to full-blown 
alcoholic episodes . . . from the behavior dis- 
orders of childhood to the emotional problems 
of old age. Why? Because it gives you maximum 
adaptability of dosage . . . works quickly and 
predictably ... is unsurpassed in safety. 

Atarax offers extra pharmacologic actions 
especially useful in certain troublesome con- 
ditions. It is antihistaminic and mildly anti- 
arrhythmic, does not stimulate gastric secre- 
tions. Hence it is well suited to the needs of 
your allergic, cardiac and ulcer patients. 

Have you discovered all the benefits of 

ATARAX? 

Dosage: Adults, one 25 mg. tablet, or one tbsp. Syrup 
q.i.d. Children, 3-6 years, one 10 mg. tablet or one tsp. 
Syrup t.i.d.; over 6 yeprs, two 10 mg. tablets or two tsp. 
Syrup t.i.d. 



Supplied: Tiny 10 mg., 25 mg., and 100 mg. tablets, bot- 
tles of 100. Syrup, pint bottles. Parenteral Solution: 
25 mg./cc. in 10 cc. multiple-dose vials; 50 mg./cc. in 
2 cc. ampules. Prescription only. 

Complete bibliography available on request. 

at a MX 



(BRAND OF HYDROXYZINE) 



PASSPORT TO TRANQUILITY 



New York 17, N. Y. 

Division, Chas. Pfizer & Co., Inc. 

Science for the World's Well-Being" 





VITERRA 



(g) for vitamin-mineral supplementation 
capsules * tastitabs® 
therapeutic capsules 



In over five yean 



Proven 

in more than 750 published clinical studies 

Effective 

for relief of anxiety and tension 

Outstandingly Safe 

1 simple dosage schedule produces rapid, reliable 
tranquilization without unpredictable excitation 

2 no cumulative effects, thus no need tor difficult 
dosage readjustments 

r\ does not produce ataxia, change in appetite or libido 

does not produce depression, Parkinson-like symptoms, 
^ jaundice or agranulocytosis 

S does not impair mental efficiency or normal behavior 



Milt own 

meprobamate {Wallace) 

Usual dosage: One or two 400 mg. tabids t.i.d. 
Supplied: 400 my. scored tabids, "00 ins*. sni;ai -mated tablets. 
Also as mH'Koi'abs* — 400 nig, unmarked, coated tablets; and 
as mi j'Kosi'AY- — 1UU nig. and 200 nig. continuous release capsules. 

\¥/* WALLACE LABORATORIES / Cranbitiy, N. /. 



( 



\ 



of clinical use 







... for the tense and nervous patient 

Despite the introduction in recent years of "new and different" tranquil- 
izers, Miltown continues, quietly and steadfastly, to gain in acceptance. 
Meprobamate (Miltown) is prescribed by the medical profession more than 
any other tranquilizer in the world. 

The reasons are not hard to find. Miltown is a known drug. Its few side 
effects have been fully reported. There are no surprises in store for either 
the patient or the physician. 



u 



Gratifying" relief from 



for your patients with 
'low back syndrome' and 
other musculoskeletal disorders 

POTENT muscle relaxation 
EFFECTIVE pain relief 
SAFE for prolonged use 



stiffness and pain 

i^XdXll y llli^ relief from stiffness and pain 

in 106-patient controlled study 

(as reported mJ.A.M.A., April 30, 1960) 

"Particularly gratifying was the drug's [Soma's] 
ability to relax muscular spasm, relieve pain, and 
restore normal movement ... Its prompt action, 
ability to provide objective and subjective assist- 
ance, and freedom from undesirable effects rec- 
ommend it for use as a muscle relaxant and anal- 
gesic drug of great benefit in the conservative 
management of the 'low back syndrome'." 

Kestler, O.: Conservative Management of "Low Back Syndrome" , 

J.A.M.A. 172: 2039 (April 30) I960. 

FASTER IMPROVEMENT- 79% complete or marked 

improvement in 7 days (Kestler) 

EASY TO USE— Usual adult dose is one 350 mg. tablet 
three times daily and at bedtime. 

SUPPLIED: 350 mg., white tablets, bottles of 50. 

For pediatric use, 250 mg., orange capsules, bottles of 50. 

Literature and samples on request. 




(CARISOPRODOL, WALLACE) 



ygf WALLACE LABORATORIES, CRANBURY, NEW JERSEY 



now-for 
more comprehensive 

control of 




INDICATIONS 

Head: temporomandibular 
muscle spasm • Neck: acute 
torticollis, osteoarthritis of cer- 
vical spine with spasm of cervical 
muscles, whiplash injury • Trunk and Chest: costochondritis, intercostal myositis, xiphodynia • Back: 
acute and chronic lumbar strains and sprains, acute low back pain (unspecified), acute lumbar arthritis 
and traumatic injury, compression fracture, herniated intervertebral disc, post-disc syndrome, strained 
muscle(s) • Extremities: acute hip injury with muscle spasm, ankle sprain, arthritis (as of foot or knee), 
blow to shin followed by muscle spasm, bursitis, spasm or strain of muscle or muscle group, old fracture 
with recurrent spasm, Pellegrini-Stieda disease, tenosynovitis with associated pain and spasm. 




-pain due to 

or 
-spasm of skeletal muscle 

a new muscle relaxant-analgesic 




Many conditions, painful in themselves, often give rise to spasm of skeletal muscles. 
ROBAXISAL, the new dual-acting muscle relaxant-analgesic, treats both the pain and 
the spasm with marked success: In clinical studies on 311 patients, 12 investigators 1 
reported satisfactory results in 86.5%. Each ROBAXISAL Tablet contains: 

• A relaxant component— Robaxin* — widely recognized for its prompt long-lasting relief of 
painful skeletal muscle spasm, with unusual freedom from undesired side effects WU mg. 

• Methocarbamol Robins. U.S. Pat. No. 2770649- 

. An analgesic component— aspirin— whose pain-relieving effect is markedly enhanced by Robaxin, 
and which has added value as an anti-inflammatory and anti-rheumatic agent. . . . (i gr.) JZi mg. 



INDICATIONS: Robaxisal is indicated when analgesic as 
well as relaxant action is desired in the treatment of skeletal 
muscle spasm and severe concurrent pain. Typical condi- 
tions are disorders of the back, whiplash and other trau- 
matic injuries, myositis, and pain and spasm associated with 
arthritis. 



SUPPLY: Robaxisal Tablets (pink-and-white, laminated) 
in bottles of 100 and 500. 

Also available: Robaxin Injectable, 1.0 Gm. in 10-cc am- 
pul. Robaxin Tablets, 0.5 Gm. (white, scored) in bottles of 
50 and 500. 



■Clinical reports 
C. Freeman, Jr. 
Chicago Heights, 



lorts in files of A H Robins Co.. Inc.. from: J. Allen, Madison. Wise.. B. Billow. New York N. Y B. Decker. Richmond Va 
*£. Aulusta Ga. k. B Gordon, New York. NY., J. E. Holmblad Schenectady. N Y. L Ley. New York N. Y N Lo B ue. 
ights\ HI . H. Nachman. Richmond. Va.. A. Poindexier. Los Angeles. Cal.. E. Rogers. Brooklyn. N. Y . K. H. Strong. rairteld. la. 

Additional information available upon request. 

Making today's medicines with integrity . . . seeking tomorrow's with persistence 




XIV 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Sep 




When you want to reduce serum cholesterol 

and maintain it at a low level, is medication more 

realistic than dietary modifications? 




Maintenance of lowered cholesterol concentration in the blood 
is a life-long problem. It is usually preferable, therefore, 
to try to obtain the desired results through simple 
dietary modification. This spares the patient added expense 
and permits him meals he will relish. 



The modification is based on a diet to maintain 

optimum weight plus a judicious substitution 

of the poly-unsaturated oils for the saturated fats. 

One very simple part of the change is to cook the 

selected foods with poly-unsaturated Wesson. 

In the prescribed diet, this switch in type of fat 

will help to lower blood serum cholesterol and 

help maintain it at low levels. The use of Wesson 

permits a diet planned around many favorite 

and popular foods. Thus the patient finds it a 

pleasant, easy matter to adhere to the prescribed course. 



Where a vegetable (salad) oil is medically recom- 
mended lor a cholesterol depressant regimen, Wesson 
is unsurpassed by any readily available brand. 
Uniformity you can depend on. Wesson has a poly- 
unsaturated content better than 50% . Only the lightest 
cottonseed oils of highest iodine number are selected 
for Wesson. No significant variations are permitted in 
the 22 exacting specifications required before bottling. 




Wesson satisfies the most exacting appetites. To be 

effective, a diet must be eaten by the patient. The 
majority of housewives prefer Wesson particularly by 
the criteria of odor, flavor (blandness) and lightness of 
color. (Substantiated by sales leadership for 59 years 
and reconfirmed by recent tests against the next 
leading brand with brand identification removed, among 
a national probability sample.) 



September, 19G0 



ADVERTISEMENTS 



XV 



Chicken, grilled with homemade 
Wesson barbecue sauce, is low in 
saturated fat — and delicious eating. 
It gives longer lasting satisfaction. 





FREE Wesson recipes, available in 

quantity for your patients, show how to 
prepare meats, seafoods, vegetables, salads 
and desserts with poly-unsaturated 
vegetable oil. Request quantity needed from 
The Wesson People, Dept. N., 

210 Baronne St., New Orleans 12, La 



Wesson's Important Constituents 

Wesson is 100% cottonseed oil . . . 

winterized and of selected quality 
linoleic acid glycerides (poly-unsaturated) 50-55% 

Oleic acid glycerides (mono-unsaturated) 16-20% 

Total unsaturated 70-75% 

Palmitic, stearic and myristic glycerides (saturated) 25-30% 
Phytosterol (predominantly beta sitosterol) 0.3-0.5% 

Total tocopherols 0.09-0.12% 

Never hydrogenated— completely salt free 



XVI NORTH CAROLINA MEDICAL JOURNAL September, 1960 




WHEN ULCEROGENIC FACTORS KEEP ON WORKING... 







September, 1960 



ADVERTISEMENTS 



XVII 





REMEMBER THIS: SO DOES ENARAX 




Think of your patient with peptic ulcer— or with gastrointestinal 
dysfunction — on a typical day. 

Think of the anxieties, the tensions. 

Think, too, of the night: the state of his stomach emptied of food. 

Disturbing? 

Then think of enarax. For enarax was formulated to help you control pre- 
cisely this clinical picture, enarax provides oxyphencyclimine, the in- 
herently long-acting anticholinergic (up to 9 hours of actual achlorhydria 1 ) 
. . . plus Atarax, the tranquilizer that doesn't stimulate gastric secretion. 

Thus, with b.i.d. dosage, you provide continuous antisecretory/antispas- 
modic action and safely alleviate anxiety . . . with these results: enarax 
has been proved effective in 92% of G.I. patients. 2-4 

When ulcerogenic factors seem to work against you, let enarax work 
for you. 

ENARAX 

(lO MG. OXYPHENCYCLIMINE PLUS 25 MG. ATARAX®!) A SENTRY FOR THE G.I. TRACT 

dosage: Begin with one-half tablet b.i.d. — preferably in the morning and before retiring. 
Increase dosage to one tablet b.i.d. if necessary, and adjust maintenance dose according 
to therapeutic response. Use with caution in patients with prostatic hypertrophy and only 
with ophthalmological supervision in glaucoma. 

supplied: In bottles of 60 black-and-white scored tablets. Prescription only. 

References: 1. Steigmann, F., et al.: Am. J. Gastroenterol. 33:109 (Jan.) 1960. 2. Hock, C. W.: 
to be published. 3. Leming, B. H., Jr.: Clin. Med. 6:423 (Mar.) 1959. 4. Data in Roerig Medical 

Department Files. tbrand of hydroxyzine 



FOR HEMATOPOIETIC STIMULATION 
WHERE OCCULT BLEEDING IS PRESENT 

HEPTUNA® PLUS 

THE COMPLETE ANEMIA THERAPY 




New York 17, N.Y. 

Division, Chas. Pfizer & Co., Inc. 

Science for the World's Well-Being ' 




completely c 



f the common cold 



r\ 




your patients suffering from colds, respiratory disorders and allergic states, you will 
CONTRAMAL-CP an orally effective DECONGESTANT, ANALGESIC, ANTIPYRE- 
and ANTIHISTAMINE. The inclusion of Tristamine* and Phenylephrine Hydrochlo- 
with the basic CONTRAMAL formula is designed to provide . . . MORE complete 
rol of the common cold! 



V 





*A 



stam 



by Physicians Products Company 
ontains Chlorpheniramine Maleate 
.25 mg., Phenyltoloxamine Citrate 

6.25 mg., and Pyrilamine Maleate 
2.5 m 



i 



r 



Mi 




\ 



TRAMAL-CP . . 
orange capsule con 

Acetyl-p-aminophenol 

Salicylamide 
Caffeine 
henylephrine Hydrochloride 

At ' 

ristamine ■ 



30 mg. 

5 mg. 

20 mg. 




V 



\ 



V 



rV» <*M 



samples -And 
literature 
gladly sent 
upon request, 




PRODUCTS CO., INC. 

PETERSBURG, VIRGINIA 




effective oral skeletal 
muscle relaxant 
and tranquilizer 



LETS THE PATIENT WALK 
"HEADS UP" 

in spite of torticollis. 




-^m^-^mmm 




Trancopal 

relieves pain and spasm 
associated with torticollis. 

In a recent study by Ganz, Trancopal brought considerable 
improvement or very effective relief to 20 of 29 patients 
with torticollis. 1 "The patients helped by the drug," states 
Ganz, "were able to carry the head in the normal position 
without pain." Similarly, Kearney found that in 8 of 13 
patients with chronic torticollis treated with Trancopal 
improvement was excellent to good. ". . . Trancopal is the most 
effective oral skeletal muscle relaxant and mild tranquilizer 
currently available." 2 

Lichtman, in a study of patients with various musculoskel- 
etal conditions, noted that 64 of 70 patients with torticollis 
obtained excellent to good relief with Trancopal. 3 

In a comparative study of four central nervous system 
relaxants, Lichtman reports that 26 of 40 patients 
found Trancopal to be the most effective drug. 3 



Trancopal (brand of chlormezanone) and Caplets, trademarks reg. U. S. Pat. Off. 4716 



1. Ganz. S. E.: J. Indiana A 
52:1134. July, 1959. 2. Kearney, I 
Current Therap. Res. 2:127 
1960. 3. Lichtman. A. L.: Ken 
Acad. Gen. Pract. J. 4:28. Oct., 



Olinical results with 


IrancopaF 








Excellent 


Good 


Fair 


Poor 


Total 


LOW BACK SYNDROMES 












Acute low back strain 
Chronic low back strain 
"Porters' syndrome"* 
Pelvic fractures 


25 

11 

21 

2 


19 
5 
5 
1 


8 
1 
1 


6 
1 

1 


58 

18 

28 

3 


NECK SYNDROMES 












Whiplash injuries 
Torticollis, chronic 


12 
6 


6 
2 


2 

3 


1 
2 


21 
13 


OTHER MUSCLE SPASM 












Spasm related to trauma 
Rheumatoid arthritis 
Bursitis 


15 
2 


6 

18 

6 


1 
2 
1 


1 


22 

21 
9 


TENSION STATES 


18 


2 


4 


3 


27 


TOTALS 


112 
(51%) 


70 
(32%) 


23 

(10%) 


15 

(7%) 


220 

(100%) 



*Over-reaching in lifting heavy bags resulting in sprain of upper, middle, and lower back muscles. 



Dosage: Adults, 200 or 100 mg. orally three or four times daily. 

Relief of symptoms occurs in from fifteen to thirty minutes and lasts from four to six hours. 

How Supplied: Trancopal Caplets® 

200 mg. (green colored, scored), bottles of 100. 
100 mg. (peach colored, scored), bottles of 100. 



I Ijtiitn/iob 



LABORATORIES, New York 1 8, N. Y. 



XX 



NORTH CAROLINA MEDICAL JOURNAL 



September. ISmO 



a 



extraordinarily effective diuretic..'! 1 



Efficacy and expanding clinical use are making Naturetin the 
"diuretic of choice" 2 in edema and hypertension. It maintains a 
favorable urinary sodium-potassium excretion ratio, retains a 
balanced electrolyte pattern, and causes a relatively small in- 
crease in the urinary pH. 3 More potent than other diuretics, 
Naturetin usually provides 18-hour diuretic action with just a 
single 5 mg. tablet per day — economical, once-a-day dosage 
for the patient. Naturetin c K — for added protection in those 
special conditions predisposing to hypokalemia and for patients 
on long-term therapy. 



Supplied: Naturetin Tablets, 5 mg., scored, and 2.5 mg. Naturetin 
c" K (5 c 500) Tablets, capsule-shaped, containing 5 mg. ben- 
zydroflumethiazide and 500 mg. potassium chloride. Naturetin 
c K (2,5 c 500) Tablets, capsule-shaped, containing 2.5 mg. 
benzydroflumethiazide and 500 mg. potassium chloride. For com- 
plete information consult package circular or write Professional 
Service Dept., Squibb, 745 Fifth Avenue, New York 22, N. Y. 

Pe/erences: 1. Dovid, N. A. ; Porter, G. A., and Gray, R. H. : Monographs 
on Theropy 5:60 (Feb.) 1960. 2. Friend, D. H. ; Clin. Pharm. & Therap. 1:5 
(Mar.-Apr.) 1960. 3. Ford, R. V. : Current Therap. Res. 2:92 (Mar.) 1960. 



Naturetin Naturetin °K 



Squibs 




September, 1960 



ADVERTISEMENTS 



XXI 



A. H. Robins' 
new Adabee — 
for the physician 
ivho has 
iveighed the . . . 



MOUNTING 
EVIDENCE 



AGAINST 



IN 

MULTI- 
VITAMINS 



Bi 2 AND 
FOLIC ACID 




jouroji of Medicim: 



rj 




"^•^^Lj 



Individually, folic acid and B 12 fill important clinical roles. 1 
But, increasing evidence indicates that multivitamins con- 
taining folic acid may obscure the diagnosis of pernicious 
anemia. 2 " 7 And vitamin B 12 . in indiscriminate and unneces- 
sary usage 5 " 8 is likewise blamed for this diagnostic con- 
fusion. 7 

Both folic acid and B 12 have been omitted from Adabee, in 
recognition of this growing medical concern. Also excluded 
are other factors which might interfere with concurrent ther- 
apy, such as, hormones, enzymes, amino acids, and yeast 
derivatives. Adabee supplies massive doses of therapeutically 
practical vitamins for use in both specific and supportive 
schedules in illness and stress situations. Thus, new Adabee 
offers the therapeutic advantage of sustained maximum 
multivitamin support without the threat of symptom-masking. 

references: 1. Wintrobe, M. M., Clinical Hematology, 3rd ed., 
Phila., Lea & Febiger, 1952, p. 398. 2. Goodman, L. S. and Gilman, 
A., The Pharmacological Basis of Therapeutics, 2nd. ed., New 
York, Macmillan, 1955, p. 1709. 3. New Eng. J.M., Vol. 259, No. 
25, Dec. 18, 1958, p. 1231. 4. Frohlich, E. D., New Eng. J.M., 
259:1221, 1958. 5. J.A.M.A., 169:41, 1959. 6. J.A.M.A., 173:240, 
1960. 7. Goldsmith, G. A., American J. of M., 25:680, 1958. 8. 
Darby, W. J., American J. of M., 25:726, 1958. 



ADABEE® 

Each yellow, capsule-shaped tablet contains: 



Vitamin A 
Vitamin D 

Thiamine mononitrate (Bj) 
Riboflavin (Bo) 
Pyridoxine HC1 (B 6 ) 
Nicotinamide (niacinamide) 
Calcium pantothenate 
Ascorbic acid (vitamin C) 

ADABEE? M 

Each green, capsule-shaped tablet contains Adabee plus nine 
essential minerals: 



25,000 USP units 

1,000 USP units 

15 mg. 

10 mg. 

5 mg. 

50 mg. 

10 mg. 

250 mg. 



Iron 


15.0 mg. 


Zinc 


1.5 


mg. 


Iodine 


0.15 mg. 


Potassium 


5.0 


mg. 


Copper 


1.0 mg. 


Calcium 


103.0 


mg. 


Manganese 


1.0 mg. 


Phosphorus 


80.0 


mg. 


Magnesium 


6.0 mg. 









indications: As dietary supplements for the deficiency states 
that accompany pregnancy and lactation, surgery, burns, 
trauma, alcohol ingestion, hyperthyroidism, infections, car- 
diac disease, polyuria, anorexia, cirrhosis, arthritis, colitis, 
diabetes mellitus. and degenerative diseases. Also in re- 
stricted diets, particularly peptic ulcer, in geriatrics, and in 
concurrent administration with diuretics and antibiotics. 

dosage: One or more tablets a day, as indicated, preferably 
with meals. _ _ 

new! ADABEE 

the multivitamin without B 12 or folic acid 

A. H. ROBINS COMPANY, INC. 

Richmond 20, Virginia 





I wouldn't be hooting 
all night if I were able 
to get my beak on some 

TRIAMINIC® 

to clear up my 
stuffed sinuses." 



= 



Your patient with sinus congestion doesn't give a hoot about anything 

but prompt relief. And TRIAMINIC has a pharmacologically balanced 

formula designed to give him just that. As soon as he swallows the 

and for humans tablet, the medication is transported systemically to all nasal and 

paranasal membranes — reaching inaccessible sinus cavities where 
With ol U if r hi D - U XT drops and sprays can never penetrate. TRIAMINIC thereby brings 

q TTsjTTQTfC; more complete, more effective relief without hazards of topical ther- 

apy, such as ciliary inhibition, rebound congestion, and "nose drop 
addiction." 

hid icat ions: nasal and paranasal congestion, sinusitis, postnasal drip, 
upper respiratory allergy. 

Relief is prompt and prolonged Each Triaminic timed-release Tablet provides: 

because of this special timed-release action: raSffiSTSJKrt! HC '. :.'.'.'.'.'.'.'.'.'.'.. . IsSfi 

Pyrilamine maleate 25 mg. 

fir<tt —the outer laver Dosage: 1 tablet in the morning, midafternoon and at bedtime. 

^A^K dissolves within '" Postnasal drip, 1 tablet at bedtime is usually sufficient. 

_ ^ minutes to produce Each timed-release Triaminic Juvelet® provides: 

^^^^ I 3 to 4 hours of relief ,. .. . ... . .. _ . . . _, ,, . 

^^ \^_ ^/ % the formulation of the Triaminic Tablet. 

"~^\ ^nen — the core Dosage: 1 Juvelet in the morning, midafternoon and at bedtime, 

disintegrates to ,-, , ,_ , , , _, . . . „ ., 

give 3 to 4 more Each tsp - ( 5 ml ^ °* "TOfllMltC Syrup provides: 

hours of relief % the formulation of the Triaminic Tablet. 

Dosage (to be administered every 3 or 4 hours) : 
Adults — 1 or 2 tsp.; Children 6 to 12 — 1 tsp.; 
Children 1 to 6 — % tsp.; Children under 1 — l A tsf. 

JL. -LT\j JL^Tjk. XV JL -L JL^I J- \~*S timed-release tablets, juvelets, and syrup 




running noses '-^> ^-, and open stuffed noses orally 



SMITH-DORSEY • a division of The Wander Company • Lincoln, Nebraska 



T 

Mo 
inti 

::; 
the 
ill 
thi; 
.:: 






. : ■ ., .; 



\ 



Doctors, too, like "Premarinl' 



The doctor's room in the hospital 
is used for a variety of reasons. 
Most any morning, you will find the 
internist talking with the surgeon, 
the resident discussing a case with 
the gynecologist, or the pediatrician 
in for a cigarette. It's sort of a club, 
this room, and it's a good place to 
get the low-down on "Premarin" 
therapy. 



If you listen, you'll learn not only 
that doctors like "Premarin," but 
why they like it. 

The reasons are fairly simple. 
Doctors like "Premarin," in the first 
place, because it really relieves the 
symptoms of the menopause. It 
doesn't just mask them — it replaces 
what the patient lacks — natural es- 
trogen. Furthermore, if the patient 



is suffering from headache, insomnia, 
and arthritic-like symptoms due to 
estrogendeficiency,"Premarin"takes 
care of that, too. 

"Premarin," conjugated estrogens 
(equine), is available as tablets and 
liquid, and also in combination with 
meprobamate or methyltestosterone. 
Ayerst Laboratories • New York 
16, N. Y. • Montreal, Canada 





What's she doing that's of medical interest? 



5 drinking a glass of pure Florida 
ge juice. And that's important to 
physician for several reasons. 
ow your patients obtain their vita- 
: or any of the other nutrients found 
trus fruits is of great medical inter- 
■ considering the fact there are so 
y wrong ways of doing it, so many 
titutes and imitations for the real 

g- 

ctually, there's no better way for 
young lady to obtain her vitamin C 
i by doing just what she is doing, 



for there's no better source than oranges 
and grapefruit ripened in the Florida 
sunshine. There's no substitute for the 
result of nature's own mysterious chem- 
istry, flourishing in the warmth of this 
luxurious peninsula. 

An obvious truth, you might say, but 
not so obvious to the parents of many 
teen-agers. 

We know that a tall glass of orange 
juice is just about the best thing they 
can reach for when they raid the refrig- 
erator. We also know that if you en- 



courage this refreshing and healthful 
habit among your young patients — and 
for that matter, your patients of any age 
— you'll be helping them to the finest 
between-meals drink there is. 

Nothing has ever matched the quality 
of Florida citrus— watched over as it 
is by a State Commission that enforces 
the world's highest standards for quality 
in fresh, frozen, canned or cartoned 
citrus fruits and juices. 

That's why the young lady's activities 
are of medical interest. 

©Florida Citrus Commission, Lakeland, Florida 




in premenstrual tension 

only 
treats the whole syndrome 



o Bromth 








It was the introduction of neo Bromth several years ago that created such widespread 
interest in the premenstrual syndrome — because of neo Bromth's specific ability 
to prevent the development of the condition in the first place. 

The action of neo Bromth is not limited merely to control of abnormal water retention, 
or of nervousness, or of pain — or any other single or several of the multiple 
manifestations characteristic of premenstrual tension, neo Bromth effectively controls 
the whole syndrome. 

neo Bromth is also completely free from the undesirable side effects associated with 
such limited-action therapy as ammonium chloride, hormones, tranquilizers and potent 
diuretics, neo Bromth has continued to prove to be the safest — as well as the most 
effective — treatment for premenstrual tension. 

Each 80 mg. tablet contains 50 mg. Pamabrom, and 30 mg. pyrilamine maleate. 
Dosage is 2 tablets twice daily (morning and night) beginning 5 to 7 days before 
menstruation. Discontinue when the flow starts. 

BRAYTEN PHARMACEUTICAL COMPANY . Chattanooga 9, Tennessee 



m 



NEW For the 

multi-system disease 

HYPERTENSION 




" — nuiA 




Hydroflumethiazide • Reserpine • Protoveratrine A 



UTEf 



In each SALUTENSIN Tablet: 
Saluron® (hydroflumethiazide) — 

a saluretic-antihypertensive 50 mg. 

Reserpine — a tranquilizing drug with 

peripheral vasorelaxant effects 0.125 mg. 

Protoveratrine A — z centrally mediated 

vasorelaxant 0.2 mg. 



An integrated multi-therapeutic 
antihypertensive, that combines in balanced pro- 
portions three clinically proven antihypertensives. 

Comprehensive information on dosage and precautions 
in official package circular or available on request. 

BRISTOL LABORATORIES • Syracuse, New York 



September, 1960 



ADVERTISEMENTS 



XXVII 



Following determination 
of basal secretion, 
intragastric pH was 
continuously determined 
by means of frequent 
readings over a 
two-hour period. 

P H Data based on pH measurements in 11 patients with peptic ulcer* 




4.9 



Neutralization 
with new Creamalin 



4.5 



3.S i ; 



3.0 



2.5 



i J 


A 3-5 






1 


Neutralization \ 
with standard 
aluminum hydroxide 


^^3.1 


"\2.0 



m neutralization 
is much 
faster and 
twice 
as long 
with 



Minutes 20 



60 



80 



120 



■" CREAMALIN ANTAC, ° 




LABORATORIES ■ 
New York 18, N. Y. 



TABLETS 



New proof in vivo' of the much greater efficacy of new Creamalin 
tablets over standard aluminum hydroxide has now been ob- 
tained. Results of comparative tests on patients with peptic ulcer, 
measured by an intragastric pH electrode, showthat newCreamalin 
neutralizes acid from 40 to 65 per cent faster than the standard 
preparation. This neutralization (pH 3.5 or above) is maintained 
for approximately one hour longer. 

New Creamalin provides virtually the same effects as a liquid 
antacid 2 with the convenience of a tablet. 
Nonconstipating and pleasant-tasting, new Creamalin antacid 
tablets will not produce "acid rebound" or alkalosis. 
Each new Creamalin antacid tablet contains 320 mg. of specially 
processed, highly reactive, short polymer dried aluminum hy- 
droxide gel (stabilized with hexitol) with 75 mg. of magnesium 
hydroxide. Minute particles of the powder offer a vastly increased 
surface area for quicker and more complete acid neutralization. 

Dosage: Gastric hyperacidity — from 2 to 4 tablets as necessary. Peptic 
ulcer or gastritis — from 2 to 4 tablets every two to four hours. Tablets may 
be chewed, swallowed whole with water or milk, or allowed to dissolve 
in the mouth. How supplied: Bottles of 50, 100, 200 and 1000. 
1. Data in the files of the Department of Medical Research, Winthrop 
Laboratories. 2. Hinkel, E. T., Jr.; Fisher, M. P., and Tainter, M. L.: J. Am. 
Pharm. A. (Scient. Ed.) 48:384, July, 1959. 

for peptic ulcere gastritis* gastric hyperacidity 




Sometimes, 
when I have 
a running nose, 
I'd like to 
clear it with 

TRIAMINIC^ 
just to check out 
that systemic 
absorption business. 

Reaches all nasal 
and paranasal 
membranes, huh?" 



. . . and for humans ^ ou can't reach the entire nasal and paranasal mucosa by putting 

medication in a man's nostrils — any more than you could by trying to 
With pour it down an elephant's trunk. TRIAMINIC, by contrast, reaches all 

: ?TTN"MT'Nrr "NTOCJTT Q respiratory membranes systemicaMy to provide more effective, longer- 

lasting relief. And TRIAMINIC avoids topical medication hazards such 
as ciliary inhibition, rebound congestion, and "nose drop addiction." 

Judications: nasal and paranasal congestion, sinusitis, postnasal drip, 
upper respiratory allergy. 

ielief IS prompt and prolonged Each Triaminic timed-release Tablet provides: 

because of this special timed-release action: Phenylpropanolamine hci . .50 mg. 

Pheniramine maleate 2o mg. 

Pyrilamine maleate 25 mg. 

first— the outer laver Dosage: 1 tablet in the morning, midafternoon and at bedtime, 

dissolves within ' ' n P ostnasa ' drip, 1 tablet at bedtime is usually sufficient. 

minutes to produce Each timed-release Triaminic Juvelet® provides: 

3 to 4 hours of relief ,, ., - ... . ,, _ . „ ,, . 

\z the formulation of the Triaminic Tablet. 

then— the core Dosage: 1 Juvelet in the morning, midafternoon and at bedtime. 

disintegrates to „ , . ,„ , , , m . . . . , 

give 3 to 4 more ' tsp ' ^ 5 ""•' o) Tr ' aml>uc Syrup provides: 

hours of relief '' tne i° rm "lation of the Triaminic Tablet. 

Dosage (to be administered every 3 or 4 hours) : 

Adults — 1 or2 tsp.; Children « to 12- 1 tsp.; 

Children 1 to 6 — Vi tsp.; Children under 1 — Vt tsp. 

J- -L \j -L ^» A. -L V -1_ X i. i JL V»y timed-release tablets, jtii'elets, and syrup 
j| running noses ^t-, ^^ an< ^ °P en stuffed noses orally 




SMITH-DORS EY • a division of The Wander Company • Lincoln, Nebraska 



September, 1960 



ADVERTISEMENTS 



XXIX 



ALL OVER AMERICA! 

KENTwiththe MICRONITE FILTER 

IS SMOKED BY 
MORE SCIENTISTS and EDUCATORS 

than an y other ci g arette !* 



FIVE 


TOP 


BRANDS 


OF 


CIGARETTES 




SMOKED 


BY AMERICAN 


SCIENTISTS 




KENT. 










15.3% 


BRAND "A" 1 
BRAND "G c 










10.5% 
7.9% 


BRAND F a 










7.6% 


BRAND "B 










7.3% 



FIVE TOP BRANDS OF CIGARETTES 
SMOKED BY AMERICAN EDUCATORS 

KENT ■■■■■■■■■■■.^■■■^■^■■■■■H 20.2% 

BRAND "G KiwM aeffi 6.0% 

BRAND "E' S3KS5s*sssss*sas 7.7% 

BRAND "A" mwH— M 7.7% 

BRAND "F" ■ " ! "■— . » 7.0% 




This does not constitute a 
professional endorsement 
of Kent. But these men, like 
millions of other Kent smokers, 
smoke for pleasure, and choose 
their cigarette accordingly. 




The rich pleasure of smoking 
Kent comes from the flavor 
of the world's finest natural 
tobaccos, and the free and 
easy draw of Kent's famous 
Micronite Filter. 



If you would like the booklet, "The Story of Kent", for your 
own use, write to: P. Lorillard Company — Research De- 
partment, 200 East 42nd Street, New York 17, New York. 

For good smoking taste, 
it makes good sense to smoke 

;fc Results ot a continuing study of cigarette preferences, conducted by O'Brien Sherwood Associates, N Y., NY. 
A PRODUCT OF P LORILLARD COMPANY FIRST WITH THE FINEST CIGARETTES THROUGH LORiLLARD RESEARCH 



I0-S1II. 
IEOULAI Sill 

Ol Crush PIOOF lot 




C i«o, f. iowuasd CO. 




You see an improve- 
ment within a few days 
Thanks to your prompt 
treatment and the 
smooth action of Deprol, 
her depression is 
relieved and her anxiety 
and tension calmed — 
often in a few days. She 
eats well, sleeps well 
and soon returns to her 
normal activities. 



4\ 




Lifts depression. ..as it calms anxiety! 

Smooth, balanced action lifts depression as 
it calms anxiety. . . rapidly and safely 



Balances the mood — no "seesaw" effect 
of amphetamine -barbiturates and ener- 
gizers. While amphetamines and energizers may 
stimulate the patient — they often aggravate 
anxiety and tension. 

And although amphetamine-barbiturate combina- 
tions may counteract excessive stimulation — they 
often deepen depression. 

In contrast to such "seesaw" effects, Deprol's 
smooth, balanced action lifts depression as it calms 
anxiety — both at the same time. 



Dosage: Usual starting dose is 1 tablet 
q.i.d. When necessary, this dose may be grad- 
ually increased up to 3 tablets q.i.d. 

Composition: 1 mg. 2-diethylaminoethy] benzi- 
late hydrochloride tbenactyzine HC1I and 400 mg. 
meprobamate. Supplied: Bottles of 50 light-pink, 
scored tablets. Write for literature and samples. 



Acts swiftly— the patient often feels 
better, sleeps better, within a few days. 

Unlike the delayed action of most other antide- 
pressant drugs, which may take two to six weeks 
to bring results, Deprol relieves the patient quickly 
—often within a few days. Thus, the expense to the 
patient of long-term drug therapy can be avoided. 

Acts safely — no danger of liver damage. 

Deprol does not produce liver damage, hypoten- 
sion, psychotic reactions or changes in sexual 
function — frequently reported with other anti- 
depressant drugs. 



A Deprol 



A® 






WALLACE LABORATORIES/AVw Brunswick, N. J. 



w h o coughed? 




u 



WHENEVER COUGH THERAPY 
IS INDICATED 

HYCOMINE 



Syrup 



cough sedative / antihistamine 
decongestant / expectorant 



THE COMPLETE Rx 
FOR COUGH CONTROL 



relieves cough and associated symptoms in 15-20 
minutes ■ effective for 6 hours or longer ■ pro- 
motes expectoration ■ rarely constipates ■ agree- 
ably cherry-flavored 

Each teaspoonful (5 cc.) of Hycomine* Syrup contains: 
Hycodan® 

Dihydrocodeinone Bitartrate 5 mg."| 

(Warning: May be habit-forming) > 6.5 mg. 

Homatropine Methylbromide 1.5 mg.j 

Pyrilamine Maleate 12.5 mg. 

Phenylephrine Hydrochloride 10 mg. 

Ammonium Chloride 60 mg. 

Sodium Citrate 85 mg. 

Average adult dose: One teaspoonful after meals and at bedtime. 
May be habit-forming. Federal law permits oral prescription. 

Literature on request 

ENDO LABORATORIES 

Richmond Hill 18, New York 

, ?U.S. Pat. 2,630.400 




Dimetane 



i distinguished by its 
'. . .very low incidence of 
undesirable side effects . . ."* 









■ 



HIHIHI 



9amt 




even m 
allergic 
infants 



FROM A CLINICAL STUDY* IN ANNALS OF ALLERGY 



Patients 


200 infants and children, ages 2 months to 14 years 


Diagnosis 


Perennial allergic rhinitis 


Therapy 


Dimetane Elixir 


Results 


in 149, good results / in 40, fair results 


Side Effects 


Encountered in only 7 patients (in all except one, 
the side effect was mild drowsiness) 



\ 






■ 



In allergic patients of all ages, Dimetane has been shown to work with an effec- 
tiveness rate of about 90% and to produce an exceptionally low incidence 
of side effects. Complete clinical data are available on request to the Medical 
Department. Supplied: dimetane Hxientabs (12 mg.), Tablets l§^tfttt^: 
(4 mg.), Elixir (2 mg./5 cc), new dimetane-ten Injectable (l^Sfl^aR 
(10 mg./cc.) or new dimetane-100 Injectable (100 mg./cc). '/Sl^SMA 






NNALS OF ALLEROY 17:913, 1951). 



A. H. ROBINS CO., INC., RICHMOND 20, VIRGINIA/ETHICAL PHARMACEUTICALS OF MERIT SINCE 1878 

t PARABROMDYLAMINE MALEATE 



3 



> -yv 







Ai 




ACUTE BRONCHITIS 



SYNCILLIN 

250 mg. t.i.d. - 6 days 




H.F. 45-year-old white female. First seen on 
Aug. 24, 1959 with acute bronchitis of 3 days 1 
duration. Culture of the sputum revealed alpha 
hemolytic streptococci. A 250 mg. SYNCILLIN 
tablet was administered 3 times daily. Another 
sputum culture taken on Aug. 27 showed no growth. 
On Aug. 30, the patient appeared much improved 
and SYNCILLIN was discontinued. 
Recovery uneventful. - *k 



Actual case summary from the files of Bristol Laboratories' Medical Department 




THE ORIGINAL potassium phenethicillin 



SYNCILLIN 

(Potassium Penicillin- 152) 
A dosage form to meet the individual requirements of patients of all ages in home, office, clinic, and hospital : 

Syncillin Tablets - 250 mg. (400,000 units) . . . Syncillin Tablets - 125 mg. (200,000 units) 

Syncillin for Oral Solution - 60 ml. bottles - when reconstituted, 125 mg. (200,000 units) per 5 ml. 

Syncillin Pediatric Drops - 1.5 Gm. bottles. Calibrated dropper delivers 125 mg. (200,000 units) 

Complete information on indications, dosage and precautions is included in the circular accompanying each package. 



BRISTOL LABORATORIES, SYRACUSE, NEW YORK (jWroi 



XXXI V 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 




experience 
dictates 
V-CILLIN K 



fOr maximum effeCtiVeneSS Recently, Griffith' reported that V-Cillin 
K produces antibacterial activity in the serum against penicillin-sensitive patho- 
gens which is unsurpassed by any other form of oral penicillin. This helps explain 
why physicians have consistently found that V-Cillin K gives a dependable 
clinical response. 

fOr Unmatched Speed Peak levels of antibacterial activity are attained 
within fifteen to thirty minutes — faster than with any other oral penicillin. 1 

fOr UnSUrpaSSed Safety The excellent safety record of V-Cillin K is 
well established. There is no evidence available to show that any form of peni- 
cillin is less allergenic or less toxic than V-Cillin K. 

Prescribe V-Cillin K in scored tablets of 125 and 250 mg., or V-Cillin K, Pediatric, 
in 40 and 80-cc. bottles. 

1. Griffith, R. S.: Comparison of Antibiotic Activity in Sera Following the Administration of 
Three Different Penicillins, Antibiotic Med. & Clin. Therapy. 7:No. 2 (February), 1960. 

V-CILLIN K® (penicillin V potassium, Lilly) 



ELI LILLY AND COMPANY 



INDIANAPOLIS 6, INDIANA, U.S.A. 

033CO1 



North Carolina Medical Journal 

Owned and Published by 
The Medical Society of the State of North Carolina 



Volume 21 



September, 1960 



No. 9 



Meeting North Carolina's Occupational Health Needs 
Through Our State Agencies 



Emil T. Chanlett* 
Chapel Hill 



In our occupational pursuits, there are 
two important standards of measurement. 
One is external — that of productivity. The 
other is internal — that of personal gratifi- 
cation, as we seek to be worthy of our own 
self-esteem and the esteem of those who work 
and live with us. In this process importance 
of physical and mental well-being is so ob- 
vious that one wonders why so little con- 
certed study has been directed to the rela- 
tionship between occupation and health. We 
are all aware of our individual efforts in this 
matter and may even take some pride in our 
accomplishments. The particular business of 
this Occupational Health Council is to con- 
sider how we may direct our efforts in con- 
cert, with a reasonable expectation of larger 
benefits and greater returns through our in- 
tegrated strength. 

A variety of definitions have been pro- 
posed for occupational health, and many of 
these are useful. The intuitive concept of 
the term is accurate. Concretely, it means 
that employees and employers in good health 
enjoy fatter pay checks, more efficient pro- 
duction, and larger profits. Therefore, a mat- 
ter of such importance merits the expendi- 
ture of time, thought, and money. 

The factors making for good or bad health 
at work are much the same as those operat- 
ing elsewhere, although they may differ in 
character and intensity. There are accidents. 
There is exposure to poisonous gases, vapors, 
dusts, and fumes; to unusual forms of phy- 
sical energy such as radiation, noise, heat, 
and light. There is exposure to, and contrac- 
tion of, communicable diseases. There is the 
degeneration or loss of full physiologic func- 
tion of our various organs and members, in- 



♦Professor of Sanitary Engineering, the School of Public 
Health, University of North Carolina. Chapel Hill. 



eluding our skin. There are the manifold in- 
fluences that determine our feelings and 
modes of adaptation, which have much to do 
with our effectiveness and our happiness. All 
these factors are the concern of this Council, 
with the exception of the prevention of acci- 
dents in industry. Comparable councils are 
already dealing with accidents and aiding 
the agencies which face the grim task of 
reducing accident tolls. 

There are four state agencies which have 
direct responsibilities and functions in occu- 
pational health in our state. Three deal with 
the prevention and detection of and the com- 
pensation for occupational diseases. Por- 
tions of these functions are allocated by sta- 
tute to the Department of Labor, the Indus- 
trial Commission, and the State Board of 
Health. The fourth is concerned with the 
salvage through vocational rehabilitation of 
those disabled by disease or injury. The Di- 
vision of Vocational Rehabilitation within 
the State Board of Education serves the vic- 
tims not only of occupational disabilities, but 
of other misfortunes as well. The occupa- 
tional health activities of these agencies have 
been substantially confined to the narrow 
front of occupational disease control. This is 
in keeping with our North Carolina statutes 
and the codes and rules made under them 
which are explicit with regard to specific 
functions of three of the agencies. A brief 
review of their powers and functions will be 
useful. 

Department of Labor 

Our Labor Department has the powers of 
inspection, enforcement, and prosecution un- 
der all laws relating to conditions of work. 
These include rule-making powers pertain- 
ing to accidents and occupational diseases. 
Rules have been promulgated relating to all 



358 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



industries and to particular places of work, 
including requirements for adequate exhaust 
ventilation systems to remove dust, gases, 
and fumes known to be capable of producing 
occupational diseases. The Labor Depart- 
ment also regulates matters of cleanliness, 
sanitary facilities, lighting, and air-condi- 
tioning. 

The Labor Department's contribution in 
the area of occupational disease and the 
broader field of occupational health has been 
to provide legal enforcement when and where 
needed. Its field staff has provided educa- 
tional material to employers and employee 
groups, and has collaborated in special 
courses for supervisory personnel and those 
particularly concerned with safety and 
health. In its series of industrial safety 
courses conducted in cooperation with North 
Carolina State College, the environmental 
phases of occupational disease control have 
received attention. 

The field staff of safety supervisors and 
inspectors of the Labor Department have 
provided, through their observation during 
routine visits, many leads on hazardous situ- 
ations capable of producing occupational dis- 
ease. These have been referred to the staff 
of the State Board of Health for study and 
recommendations. The Department's activi- 
ties, although directed primarily to the pre- 
vention of accidents, has prepared the 
groundwork among employers and employees 
for a better understanding of their joint re- 
sponsibilities for health and safety. 

Indiistrial Com mission 

All of us are familiar with the over-all re- 
sponsibilities of the Industrial Commission, 
an autonomous administrative agency with- 
in the Labor Department. Its responsibili- 
ties for occupational health are clearly de- 
fined in terms of occupational diseases. This 
agency is responsible for the adjudication of 
compensation claims arising from any of the 
specifically stated 26 causes or conditions 
capable of producing occupational disease. 
In compensation law our North Carolina act 
is referred to as a scheduled coverage of oc- 
cupational diseases, as claims may be made 
only for the causes or conditions stated in 
the law. The Industrial Commission has had 
a particular concern for claims arising from 
silicosis and asbestosis, as these conditions 
had much to do with the creation of our com- 
pensation law. The statute creating the In- 



dustrial Commission requires the reporting 
of occupational disease, and provides for a 
medical advisory committee to assist in eval- 
uating cases and for determining the fitness 
of employees for work in the dusty trades. 

The Industrial Commission has faithfully 
administered our compensation law, includ- 
ing the orderly and rapid processing of 
claims arising from occupational diseases 
with a continued emphasis and stress upon 
the diseases arising in the dusty trades. The 
staff of the Commission has provided safety 
instruction, through organized classes, 
through its publications, and through the 
promotion of the Annual State-Wide Safety 
Conference. In all these media, the import- 
ance of occupational diseases as a cause of 
disability and death has received compelling 
attention. 

The Industrial Commission is an indis- 
pensable and valuable source of statistical 
data on the cases, claims, disabilities, and 
deaths arising from occupational diseases, 
and on the direct cost which these impose 
upon us all. A by-product of one of its stud- 
ies of factors contributing to industrial ac- 
cidents is new knowledge on the importance 
of healthful living to the efficiency and hap- 
piness of employees. A staff study has shown 
that the sort of breakfast eaten and how a 
weekend is spent influence the frequency and 
time of occurrence of industrial accidents. 
These observations recently captured nation- 
wide attention. It was certainly an interest- 
ing hint of the potential that we have for 
working together in occupational health. 

Division of Vocational Rehabilitation 
The Division of Vocational Rehabilitation 
has the function of renewing people for em- 
ployment who have been disabled, through 
any means, in any place, or under any con- 
ditions. Its services are not restricted to 
those whose disability has been incurred in 
the course of employment. Working coop- 
eratively with a federal agency, this organi- 
zation provides services for the disabled 
which embrace medical repair, counsel, guid- 
ance and training, and assistance in finding 
a new and productive place in our society. 
It is a process of restoration which pays rich 
dividends in self-respect and in lightening 
the community's cost for carrying the un- 
fortunate. 

State Board of Health 
Our State Board of Health has general 
as well as specific powers and responsibili- 



September, 1960 



MEETING OCCUPATIONAL HEALTH NEEDS— CHANLETT 



359 



ties with regard to occupational health. Un- 
der its general powers relating to health and 
sanitary conditions, the power to investigate 
the effect of employment upon the public 
health is specifically mentioned. 

The Occupational Health Section of the 
State Board of Health, formerly known as 
the Division of Industrial Hygiene, is desig- 
nated as the technical and professional agent 
of the Industrial Commission for the detec- 
tion and prevention of occupational diseases 
and for medical advice in the adjudication 
of claims. Although its activities have been 
closely related to the needs of the Industrial 
Commission, the Occupational Health Sec- 
tion is an integral part of the State Board 
of Health. A small group of specialized per- 
sonnel was originally made possible through 
federal funds to which this state was entitled 
under the Social Security Act. Federal as- 
sistance continues, although there is now 
substantial support from the state. The staff 
presently consists of a medical director, an 
industrial nurse, two industrial hygiene en- 
giners, two industrial hygienists, x-ray tech- 
nicians, and secretarial personnel. 

This group directly serves the dusty trades 
by providing x-ray examinations of all em- 
ployees exposed to silica or asbestos dust, 
with further physical evaluation when 
needed. A physician supplies medical infor- 
mation for compensation hearings through 
reports, affidavits, and even direct testimony 
when required. A field engineering staff car- 
ries out an extensive schedule of air-samp- 
ling to determine dust concentration where 
silica or asbestos are present. This same 
group makes recommendations for dust con- 
trol by appropriate engineering methods 
such as ventilation, isolation, and wetting. 

In spite of the fact that the direct services 
rendered the dusty trades make heavy de- 
mands on the time and funds of the small 
staff, the group has provided medical and 
engineering services as well as air-sampling 
in all instances of known or suspected cases 
of occupational disease which have been 
brought to its attention. Requests for such 
services arise from the Industrial Commis- 
sion, the Labor Department, the North Caro- 
lina Rating Bureau, from industrial man- 
agement and employee groups, and occa- 
sionally from local health departments. 
There have been numerous field studies of 
exposure to such notorious toxic substances 
as lead, benzol, zinc oxide, vapors of paint 
solvents, and exposure to radiation from ra- 



dium, polonium, and radioisotopes. There is 
liaison with the U. S. Atomic Energy Com- 
mission when the latter inspects licensed 
users of AEC material in North Carolina. 

The professional engineering staff of the 
Occupational Health Service has initiated 
survey studies on such matters as x-ray shoe- 
fitting machines, x-ray and fluoroscopic ma- 
chines used in health departments, hospitals, 
and physicians' offices ; on exposure to sol- 
vent vapors in the furniture industry; and 
on carbon monoxide from heating devices in 
motels and tourist cabins. This staff has pro- 
vided consultant service on exhaust ventila- 
tion for the control of toxic vapors, gases, 
fumes, and dusts. Such service has reached 
plants in many parts of our state, with much 
of it directed to smaller organizations which 
did not have ready access to technical 
knowledge. 

The one area in which the activities of the 
Occupational Health Section of the State 
Board of Health have not been directly ori- 
ented to occupational disease prevention and 
control is that of consultation to industrial 
nurses. This activity was limited in scope, 
time, and geography until the present year. 
Until 1958 it was carried on by a nurse 
stationed in Asheville who could only devote 
part of her time in industrial nursing activi- 
ties. Beginning this year, a competent, full- 
time nurse is assigned directly to the Occu- 
pational Health Section and is giving a wider 
coverage to the some 225 industrial nurses 
employed in North Carolina, as well as con- 
sultation to establishments which are consid- 
ering employing a nurse for the benefit of 
their employees. This is looked to as a happy 
sign of occupational health activities yet to 
come. 

Limitations and Problems 

Within the limitations imposed upon them, 
these organizations have served the state ad- 
mirably, and have cooperated with one an- 
other spontaneously and well. The limita- 
tions are not only budgetary ; some are statu- 
tory. Many arise from the multitudinous du- 
ties imposed on the heads of departments 
and divisions, depriving them of time for 
thoughtful, creative development of inter- 
agency planning in the realm of occupational 
health. This has resulted in activities which 
are limited and late. This sketchy review in- 
dicates that action has been substantially 
limited to occupational disease. Even in that 
instance It has been late in the sense that 



3C0 



NUKTH CAROLINA MEDICAL JOURNAL 



Septeml> 



1960 



time and energy spent in prevention are out 
of proportion to the time, energy and money 
spent in repairing the damage which has al- 
ready been inflicted. 

The wisdom of prevention rather than cure 
becomes more apparent if we translate the 
concept into that of a tangible product of 
our industry. Such sound management prac- 
tices as quality control, preventive mainte- 
nance on machinery, and adherence to speci- 
fications of raw materials cut down the num- 
ber of costly production "lemons." Repair- 
ing, recouping, and paying off claims for pro- 
duction "lemons" that have found their way 
to the market place is a poor investment of 
the production dollar. Similarly, however ad- 
mirable and needful they may be, payments 
for hospital care, rehabilitation, and com- 
pensation claims are poor investments of the 
health dollar as long as any path of preven- 
tion has been left unexplored. 

Occupational diseases are the key to the 
broad problem of occupational health, for a 
well planned, well executed program of oc- 
cupational disease control is a stepping stone 
to employer and employee understanding and 
support of an occupational health service. 
As our compensation coverage of occupa- 
tional diseases in North Carolina is limited 
by a scheduled act, we cannot claim to have 
complete information on all these conditions. 
For the 26 specific causes and conditions 
which are compensable, a review of the 10- 
year period from 1946 to 1956 reveals that 
the compensation and medical care of victims 
of occupational disease is costing from $130,- 
000 to $150,000 per year, with the loss of 
7,000 to 7,500 working days per year. Sta- 
tistical records of the Industrial Commission 
show that the dusty trades are not the sole 
sources of claims, although the largest sums 
for single cases do arise from the mining and 
rock-quarrying industries. Among those pay- 
ing a heavy toll in lost time and compensa- 
tion claims are the cotton, woolen, and hos- 
iery mills. The furniture and machinery 
manufacturing industries are also frequently 
found among the leading five payers of com- 
pensation claims and the leading losers of 
production days due to occupational diseases. 

Analysis of the last five biennial reports of 
the Industrial Commission further shows 
that our occupational disease cases are 
widely scattered by industry types and plant 
size, and that agricultural pursuits are not 
exempt. A really significant fact is that the 
losses clue to occupational diseases are un- 



necessary. Our North Carolina organizations 
have the professional and technical knowl- 
edge and a cadre of professional persons to 
deal with the occupational disease problems 
in North Carolina industries. 

Questions That Merit Consideration 

From these rather general remarks con- 
cerning the occupational health activities of 
our State agencies, several questions may be 
drawn which merit the thoughtful considera- 
tion of this council: What is needed to make 
occupational disease control more effective? 
What devices would help to formalize and 
insure the coordination of the activities of 
the present agencies? Can our teaching hos- 
pitals participate in such services as a diag- 
nostic clinic for occupational diseases? What 
steps are needed to increase the interest of 
private physicians in the occurrence of occu- 
pational diseases among the breadwinners 
of the families they now serve? What forms 
of employer and employee education on oc- 
cupational disease hazards and their control 
are most certain of acceptance and success? 

Beyond the matter of occupational disease 
control, there is evidence of relatively little 
governmental promotion of industry sup- 
ported health services. This raises questions 
for which answers may be neither quick nor 
easy. What steps are needed to encourage 
management, workers, and doctors to under- 
take a coordinated effort to raise the level 
of occupational health in our state? What 
increases must be made in the staffs of our 
state agencies if they are to exercise leader- 
ship and be of practical help, particularly 
to our smaller plants? What steps can be 
taken to mobilize the potential contributions 
which local health departments and com- 
munity hospitals are capable of making to 
the maintenance of a higher level of health 
among the most important person in their 
communities — the wage earners? 

It is certain that these questions, incom- 
plete and poorly framed, have already raised 
many new ones in your minds. As these or 
others like them are discussed, their com- 
plexity should be neither frustrating nor dis- 
couraging. They are the daily business of 
many of us. They are matters of economic 
necessity which must be met by sound man- 
agement practices. 

Conclusion 

It has been demonstrated in the experi- 
ences of plants throughout our country, and 



September, 1960 



MEETING OCCUPATIONAL HEALTH NEEDS— CHANLETT 



361 



in some in our own state, that well planned 
occupational health work will reduce absen- 
teeism, reduce insurance costs, and make for 
higher morale and more efficient production. 
Our Governor has repeatedly expressed his 
conviction that occupational health is vital 
to the economic progress of our state. The 
work of this council will certainly contribute 
to our state drive for an increase in indus- 
trial plants and for a greater diversification 
of our agriculture. A productive occupa- 
tional health program will reduce our labor 
turnover, and will encourage more of our 



best trained workers to stay in North Caro- 
lina. This council is the platform upon which 
to develop a cooperative effort in occupa- 
tional health among employers, employees, 
state and local governmental agencies, and 
the several professions. Success in such co- 
operation is certain to enhance the attrac- 
tiveness of North Carolina resources for 
capital investors. Our goal is growth. 
Healthy and happy workers, sound in body 
and in mind, are as vital as dollars in mak- 
ing the wheels of production go round and 
in making them grow. 



Economic Influences of an Industrial Medical Program 
On a County Medical Society 



Mac Roy Gasque, M.D. 

and 

Carl S. Plumb, MD. 

Pisgah Forest 



It is a well known and accepted fact that a 
thoughtfully conceived and skillfully ren- 
dered industrial medical program can have a 
favorable economic impact on such matters 
as labor turn-over, absenteeism, and work- 
men's compensation insurance premium 
rates' 1 - 1 . It is less well known but equally 
true that such a program can also have an 
important economic effect on the private 
practice of medicine. In an effort to cast 
light on the matter, this essay will offer a 
review of a 10-year experience of physician 
participation in a company-sponsored Blue 
Cross insurance program of a relatively 
large industry. 

Approximately 11 years ago, this industry 
employed its first full-time medical director. 
A few months later, equipment, space and 
medical staff personnel were acquired. 
Thereafter a modern industrial medical pro- 
gram was gradually put into effect. 
Early Effects 

During the first several months rumblings 
of a suspicious discontent arose from the 
county medical society. Questions of this sort 
were asked : "What are you going to do with 
all that space and equipment?" "Are you go- 
ing to treat workers for their personal ill- 
nesses?" "Are you going to take care of em- 
ployees' families?" In a climate of mutual 



*Medical Director, Olin Mathie^on Chemical Corporation, Pif 
gah Forest, N. C. 



good will, the members of the county medical 
society slowly began to realize that the pri- 
mary preventive orientation of the industrial 
medical program was a viable reality and 
not just a high-sounding statement of policy 
gibberish. 

Figure 1 shows the number of claims filed 
against the company's Blue Cross insurance 
plan by physicians in the community. Dur- 
ing the early years of the study only three 
members of the county medical society were 
active in private practice. These physicians 
are designated as Doctors A, B and C. It 
can be noted that during the first three years 
of this study the claims filed by each of these 
physicians more than doubled. It is thought 
that a large part of this increase in medical 
activity was a direct result of the industrial 
medical program which, through the medium 
of employee meetings, medical films, and so 
forth, emphasized the importance of health 
and publicized the benefit program. Because 
of the growing medical opportunities, begin- 
ning in 1953 three additional physicians mi- 
grated into the community. They are repre- 
sented in figure 1 as Doctors D, E and F. 

The total number of claims per year is 
shown in figure 2. It is significant that in 
1952 the number of claims more than 
doubled. It was in this year that the services 
of a second full-time industrial physician 
were acquired. A program of periodic physi- 



362 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



INDIVIDUAL PHYSICIAN PARTICIPATION 
TEARS {50—- 59) 



P* 



m 



r * 



aad 



S3 54 55 54 ! 
Dr. A 



5) 54 55 Si 5' 58 59 
Or. B 



53 53 54 55 56 37 5B 5? S3 54 33 5* 37 

Dr. C Dr. D 



» 53 34 53 54 57 || 5* 

:>. i 



Figure 1 



cal examinations for all employees was be- 
gun, and a backlog of abnormalities was un- 
covered. As a result, literally hundreds of 
employees were referred to their personal 
physicians for additional diagnostic study 
and care. 

Although the number of employees re- 
mained essentially constant, in 1956 an- 
other sharp rise in claims occurred. In this 
year two new services were added to the 
industrial medical program: (1) an annual 
gynocologic survey 131 ; (2) a proctologic 
survey of all men over 40. These case-find- 
ing programs resulted in many additional 
referrals. 

These facts and figures give definition to 
one type of medical activity which has had 
a precise and significant impact on the 
economy of a county medical society. More 
important is the implication that these fig- 
ures provide a faithful index of a general 
increase in community medical affairs, re- 
sulting primarily from the impetus pro- 
vided by an active industrial medical pro- 
gram. 

Description of Program 
It is a fact that many physicians in pri- 



vate practice regard industrial medicine as 
a somewhat vague, third-party device which 
may potentially interfere with their private 
practice. In an effort to dispel the wariness 
that many feel with regard to the unknown, 
there follows a description of the medical 
program of the industry referred to in this 
study. With certain modifications, this pro- 
gram is typical of industrial medical prac- 
tice nationwide. 

A. Physical examinations 

1. Pre-placement physical examinations: 
The pre-placement physical examination is 
becoming standard in American industry. It 
is a multi-purpose procedure, the primary 
importance of which is to allow employers 
to bring into their organizations workers 
with known physical assets. In addition, it 
facilitates the skillful placement of workers 
with physical limitations. Rejection occa- 
sionally is necessary. 

In order for a physician to participate ef- 
fectively in the placement of workers, it is 
mandatory that he have an intimate knowl- 
edge of working conditions within the plant. 
He must know the demands, both physical, 



September, 1960 



INDUSTRIAL MEDICAL PROGRAM— GASQUE AND PLUMB 



363 




Figure 2 

emotional and intellectual, of the various 
jobs, and he should attempt to calibrate the 
assets of the candidate for employment with 
the demands of the job. 

A pre-placement physical examination can 
provide an important base-line of employee 
health against which later examinations can 
be appraised more skillfully. 

2. Periodic physical examinations: Mod- 
ern medical thinking is increasingly support- 
ing the principle of periodic physical exami- 
nations for all persons who have more than 
a casual interest in their health. Industry 
is taking the lead in this movement. This 
development has come about partly because 
of the obvious good sense of preserving man- 
power. Trained manpower represents indus- 
try's most valuable and hard-to-replace asset. 
In terms of machinery and equipment, it is a 
fact that good maintenance can prevent early 
obsolescence and, in some cases, can even 
prevent operational failure. The same idea 
is equally true when applied to an industrial 
worker. Industry has found that it is not 
necessary to stand idly by and absorb the 
losses of premature failure of manpower' 41 . 
Speaking broadly, health is not a matter of 
chance. In fact, a certain and important de- 
gree of health is purchasable. Thoughtful 
management supports this principle. The 
wisdom of the early detection of disease is 



apparent to all medically oriented persons. 
These ideas underlie industry's interest in 
periodic physical examinations. 

The techniques of an examination done in 
industry are different from those used in 
private practice. As a group, industrial 
workers come to industrial doctors as well 
patients. Their complaints are few. This 
puts the onus of responsibility for finding 
abnormalities squarely in the doctor's hands. 
He needs to be a scientifically oriented as 
well as an intuitive diagnostician. The mean- 
ing of subtle changes in physiology must be 
understood by the physician examining 
asymptomatic patients. 

3. Special examinations for workers ex- 
posed to increased hazards: In most indus- 
tries there are work areas of increased haz- 
ard, involving such matters as dust, noise, 
chemical atmospheric pollution, and chronic 
and recurrent psychologic stress. Workers 
exposed to hazards of this sort should have 
pertinent physical examinations at appro- 
priate intervals. 

4. Back-to-ivork examinations after ill- 
ness: Workers returning to their jobs after 
having suffered a significant injury or ill- 
ness should be appraised regarding their 
ability to return to their usual duties. Some- 
times — for example, after disabling injuries 
involving the bones and joints — it is neces- 
sary for employees to make permanent 
changes in their type of work. Occasionally, 
after suffering an infectious disease, an em- 
ployee will return too soon and while he is 
still a source of contagion. Obvious medical 
precautions should be enforced. 

B. Therapeutic services for 

1. Industrially induced illnesses and acci- 
dents: A nationwide pattern which provides 
definitive therapy for occupational injuries 
or diseases is being established. In most 
states, workmen's compensation legislation 
defines the responsibilities of employers 
and the limits of monetary claims by em- 
ployees. 

2. Personal illnesses and accidents: The 
appropriate extent of therapy for personal 
illnesses is a little more difficult to define. It 
is usual to provide medical care which will 
enable an employee to complete his shift or 
will provide relief of pain, and to treat minor 
conditions which would not take the em- 
ployee to his personal physician. When ther- 
apy goes beyond this point, it probablv is not 
profitable to the industry, and it usually will 



364 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



bring the industrial physician into sharp is- 
sue with local medical practitioners' ■'". Com- 
petition with or replacement of conventional 
medical agencies should be scrupulously 
avoided. The industrial physician can, how- 
ever, render valuable service by providing 
counsel and guidance concerning sources of 
specialized medical care for personal ill- 
nesses. 

The part-time industrial physician has a 
particularly delicate problem in connection 
with the treatment of personal illnesses. He 
must be continuously vigilant in order to 
avoid using his industrial relationship to 
build up a private practice. The principle of 
free choice of physician must always be kept 
in mind. Except where there is a valid per- 
sonal physician relationship with an indus- 
trial worker, referrals should be to the office 
of the worker's private physician and not to 
the office of the part-time industrial physi- 
cian. Obviously, in some situations this may 
be difficult, especially in very small commu- 
nities where the part-time industrial physi- 
cian is one of a small number of physicians 
residing in the locality. 

C. Health education 

Health education can take many forms, 
and it certainly should include the more 
usual, such as distribution of printed ma- 
terial, bulletin board posters, group lectures, 
and the like. Perhaps the most important 
way of educating an industrial population 
involves the long and sometimes tedious indi- 
vidual doctor-patient contact, as, for exam- 
ple, that which takes place at the periodic 
physical examination. These examinations 
should be carried out in a climate of warmth 
and friendliness, and they contribute to pro- 
gressive rapport. The ready availability of 
a physician who is willing and able to inter- 
pret medical questions asked by employees 
provides additional opportunity for health 
education. 

D. Industrial hygiene 

The safety of the working environment is 
the concern of the industrial hygienist. He 
monitors the work areas to determine the 
degree and hazard of exposure to chemicals, 
radiation, dust, and so forth. Activities re- 
lated to industrial hygiene are usually coor- 
dinated as a part of the services of the indus- 
trial medical department. 

E. Medical records 

An important part of any medical program 
involves good record-keeping, the principal 
reasons being: (1) They enable the progress 



to be followed of any sick or injured em- 
ployee; (2) they provide a basis for adjudi- 
cation in cases of compensable injuries; (3) 
they enable an objective industrial physician 
to appraise the activities of his department 
and, when indicated, to modify his program. 
F. Special activities 

Depending on the intellectual and person- 
ality turn of the physician and the industrial 
management which he represents, special ac- 
tivities can be conceived and carried out. 
Typical services provided in this broad cate- 
gory are : 

1. Preventive immunizations' 01 . 

2. The follow-up of workers with known 
or suspected chronic diseases, such as hyper- 
tension, obesity or diabetes. 

3. Clinical psychology services' 7 '. Indus- 
trial problems involving engineering, produc- 
tion, finances or sales are often readily amen- 
able to resolution. There is no such ready 
resolution of problems involving the ap- 
parently increasing number of psychologi- 
cally maladjusted and disturbed persons. 
The industrial psychologist is gaining status 
and increasingly is taking his place as an 
important member of the industrial medical 
team. 

4. Foot care 181 . Problems involving pain- 
ful feet are more frequent than is generally 
recognized. While not usually totally disa- 
bling, they can be distracting. A skillful 
podiatrist can offer an industry a service 
which consistently receives a warm recep- 
tion. 

•5. Proctologic and Gynecologic Surveys' 3 '. 
As a rule, assembly line techniques should 
be avoided in industrial practice. However, 
in certain types of survey activities, results 
justify the means. Part-time or visiting con- 
sultants can frequently be integrated into 
such surveys. 

6. Diabetic detection. This service should 
be continuous, and workers who visit the 
medical department should be encouraged to 
leave a specimen of urine in the clinical lab- 
oratory. This affords the opportunity to de- 
tect and put under treatment the new dia- 
betic patient in the interval between peri- 
odic physical examinations. 

Conclusion 
A program of the sort described in this 
paper can be expected to have a very fa- 
vorable economic influence on the private 
practice of medicine in an industrial com- 
munity. 



September, 1960 



INDUSTRIAL MEDICAL PROGRAM— GASQUE AND PLUMB 



365 



Traditionally the medical profession has 
been concerned with sickness and disease. 
The ground rules of industrial medicine al- 
low — even require — that doctors concern 
themselves with health — the natural history 
of health as an entity 191 . Industrial medicine 
is changing the custom of waiting for ana- 
tomic and physiologic default. Intervention 
in the interest of health promotion is a new 
pattern, and it can now be accomplished by 
the application of documented techniques of 
health education and of early detection and 
prevention of disease. 

References 

1. Casque. M. R.: Occupational Health Pays Dividends. 
North Carolina M. J. 18:154-157 (April) 1957. 



Hubbard. J. P.: The Early Detection and Prevention of 
Disease. New York. The Blakiston Press, 1957. 
Casque. M. R., Plumb, C. S.. and DeBord, M.A.: The 
"How" of an Industrial Gynecologic Survey, J. Occupa- 
tional Med. 2:214 (May) 1960. 

Seymour. W. H.: What Industry Needs from the Med- 
ical Profession, American Congress of Occupational Medi- 
cine, Mexico City, February, 1958. 

Wade, L. J.: Needed: A Closer Look at Industrial Med- 
ical Programs, Harvard Business Review 34:81 March- 
April, 1956. 

Committee on Industrial Health Emergencies of the 
Council on Industrial Health: Guide for Industrial Im- 
munization Programs, J.A.M.A. 171:2097 (Dec. 12), 1959. 
Sorkey, H.: Trends in Industrial Psychology. South. M.J. 
52:1128-1131 (Sept.) 1959. 

Casque, M.R., and Holt, G.F. : An Experiment in In- 
dustrial Foot Health. South. M.J. 46:275-278 (March), 1953. 
Gasque, M. R. : Trends and Direction in Occupational 
Medicine, South. M.J. 62:309-313 (March) 1959. 



Compensable Occupational Diseases Under the 
North Carolina Workmen's Compensation Act 



J. W. Bean* 
Raleigh 



The North Carolina Industrial Commis- 
sion is an administrative agency of the state 
which is charged with the responsibility of 
administering the North Carolina Work- 
men's Compensation Act. The Commission 
was created in 1929 by the State Legislature, 
and its duties, power, and authorities come 
from statute law, as enacted by the Legis- 
lature and as interpreted by the Supreme 
Court. 

The economic theory underlying work- 
men's compensation is referred to frequently 
as the doctrine of occupational risk. 

The history of workmen's compensation 
legislation shows that the state legislators 
intended to enact compensation laws to cover 
these fundamental points : 

1. Provide to victims of work accidents 
and occupational diseases and their depen- 
dents certain prompt and reasonable compen- 
sation, plus medical treatment for the worker 
for injuries which arose out of and in the 
course of his employment. 

2. Free the courts from delays, costs, and 
tremendous work-load of this mass of per- 
sonal injury litigation. 

3. Relieve public and private charities of 
the fundamental drain caused by uncompen- 
sated industrial accidents. 



^Chairman, North Carolina Industrial Commission. Raleigh. 



Designation of Occupational Diseases 

Under the provisions of North Carolina 
Workmen's Compensation Act, certain dis- 
eases are designated as being occupational 
diseases. The Act enumerates 27 causes or 
conditions which result in compensable occu- 
pational diseases, and defines the Commis- 
sion's responsibility for occupational health 
in terms of such diseases. 

The following diseases and conditions have 
been classified as occupational diseases with- 
in the meaning of the Act : 

1. Anthrax 

2. Arsenic poisoning 

3. Brass poisoning 

4. Zinc poisoning; 

5. Manganese poisoning 

6. Lead poisoning 

7. Mercury poisoning 

8. Phosphorus poisoning 

9. Poisoning by carbon bisulphide, methanol, 
naphtha or volatile halogenated hydrocarbons 

10. Chrome ulceration 

11. Compressed-air illness 

12. Poisoning by benzol, or by nitro and amido 
derivatives of benzol (dinitrol-benzol, anilin, and 
others) 

13. Infection or inflammation of the skin or eyes 
or other external contact surfaces or oral or nasal 
cavities due to irritating oils, cutting compounds, 
chemical dust, liquids, fumes, gases or vapors, and 
any other materials or substances 



366 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Table 1 

Summary of Occupational Diseases Handled by 

The North Carolina Industrial Commission 

July 1, 1958, through June 30, 1959 



Causes and Diseases 



Total No. 
of Cases 



Total 
Compensation 



Total 
Medical Cost 



Total 

Days Lop 



Anthrax 1 

Arsenic 16 

Asbestosis _. _. 1 

Blisters _... 8 

Bone felon 5 

Bursitis of elbow.. _ 5 

Bursitis over patella 2 

Brucellosis I 

Carbon bisulphide 3 

Carbon dioxide 1 

Carbon monoxide 16 

Caustics .... 

Cellulitis 7 

Chlorine _.. 1 

Formaldehyde 6 

Infection or inflammation to skin or 

eyes due to specific substances ._. 258 

Lead poisoning 9 

Myopia 

Nitrobenzol 

Occupational neurosis .... 

Petroleum distillates 1 

Silicosis (16)* 21 

Synovitis 28 

Wood poisoning 1 

Zinc poisoning 1 

All other poisoning 13 



10 

6,000 

456 

27 

45 

" 175 

680 

185 
"38 



210 
393 

"263 
216 
334 

81 

396 

349 

5 

1,056 



12,187 
552 



209 

89 

186 

21,387 
851 



23 

104 
17 
23 
5 
35 
36 

101 

19 



2,592 
170 



120,169 
1,216 



1,120 



20 

1,976 

1,099 

2 

63 

829 



2,231 
375 



:58 



Overall totals (16) 



405 



$142,860 



$30,014 



5,998 



14. Epitheliomatous cancer or ulceration of the 
skin or of the corneal surface of the eye due to tar, 
pitch, bitumen, mineral oil, or paraffin, or any com- 
pound, product or residue of any of these substances 

15. Radium poisoning or injury by x-rays 

16. Blisters due to use of tools or appliances in 
the employment 

17. Bursitis due to intermittent pressure in the 
employment 

18. Miner's nystagmus 

19. Bone felon due to constant or intermittent pres- 
sure in employment 

20. Synovitis, caused by trauma in employment 

21. Tenosynovitis, caused by trauma in employ- 
ment 

22. Carbon monoxide poisoning 

23. Poisoning by sulphuric, hydrochloric or hydro- 
fluoric acid 

24. Asbestosis 

25. Silicosis 

26. Psittacosis 

27. Undulant fever 

Diseases caused by the use of chemicals 
shall be termed occupational diseases only 
when the employee has been exposed to the 
chemicals mentioned above, in his employ- 
ment, in such quantities, and with such fre- 
quency as to cause the compensable disease. 

Coverage 

Claims may be made only for diseases re- 
sulting from these enumerated causes or 
conditions. Complete coverage of all occu- 



pational diseases has been the trend in work- 
men's compensation laws during recent 
years. Eighteen states, including North 
Carolina, however, cover only certain enum- 
erated diseases. Three states have no pro- 
vision whatever in their laws for coverage 
of occupational diseases, but full coverage 
can be provided for under workmen's com- 
pensation law by various methods. One is 
by simple definition of the term "injury," 
which in various states has various mean- 
ings ; in some states it includes occupational 
diseases. In other states full coverage has 
been obtained by amending the law and add- 
ing other diseases to the schedule listing of 
diseases. 

A person disabled by occupational disease, 
if it arises out of and in the course of his 
employment, should be as much entitled to 
workmen's compensation benefits as a per- 
son disabled by an accidental work injury. 
In either case the worker is actually injured, 
whether it be from disease or accident, and 
in either case the disability has arisen out 
of the worker's employment or the environ- 
mental condition of his employment. 

Claims Filed in North Carolina 
for 1958-1959 
The following table presents a recapitula- 
tion of claims for occupational diseases filed 



September, 1960 



WORKMEN'S COMPENSATION— BEAN 



367 



with the Commission during the fiscal year 
1958-1959. 

Silicosis and asbestosis constitute the ma- 
jor cost of occupational disease adjudicated 
under the North Carolina Workmen's Com- 
pensation Law. However, the incidence of 
these diseases is gradually being reduced in 
North Carolina as various safety methods 
are brought into play and as more interest 
is shown by employers and employees in 
eliminating dust hazards. 

The expanding use of atomic energy for 
industrial purposes is resulting in the ex- 
posure of more and more workers to the 



hazard of ionizing radiation. Provision of 
workmen's compensation protection for all 
gainfully employed workers who may be ex- 
posed to ionization radiation is a problem 
which needs serious study, as well as the use 
of certain new chemicals in industry. At the 
present time no one seems to know just what 
would be the best course to pursue in this 
respect. 

The use of new chemicals and atomic en- 
ergy is presenting a new challenge in the 
field of occupational diseases, and it will take 
the full cooperation of the medical profes- 
sion, the employer, the employee, and the 
general public to solve this problem. 



Radiation Hazards in Industry 



Thomas S. Ely, M.D. 
Washington, D. C. 



Recognition of the harmful effects of ion- 
izing radiation occurred shortly after the 
discovery of x-ray and radium in 1895. The 
acute effects of high doses of x-ray were seen 
in 1896 and the carcinogenic effect in 1902. 
Although cases of radiation injury have con- 
tinued to spot the record since that time, the 
potential sources were comparatively small 
until the beginning, in 1942, of what has 
been called the "Nuclear Age." In the early 
forties the vast growth of the nuclear in- 
dustry with the Manhattan Engineering Dis- 
trict, subsequently to become the Atomic 
Energy Commission, involved extremely 
large operations — a very rapid expansion — 
conducted under Federal Government control 
with a very high degree of secrecy. These 
factors contributed to the result that the nu- 
clear industry grew up with an exceptionally 
good record of radiation health control in 
contrast to most of the other industrial 
hazards, which have been controlled only 
after a certain amount of human injury was 
experienced. Another result of the unique 
beginning has been a certain aura of mystery 
surrounding radiation, radiation hazards, 
and radiation effects, which persists to a 
large extent to the present. 

The current operations of the Atomic En- 
ergy Commission are carried out mainly un- 
der contracts, and involve more than 100,000 
employees. Most of them work in large in- 



•Assistant Chief, Health Protection Branch. Office of Health 
and Safety, U. S. Atomic Energy Commission. Washington 
25, D. C. 



dustries, each of which has a well staffed 
health and safety department. 

The Atomic Energy Act of 1954 provided 
for a program of radioisotope licenses, which 
has greatly expanded the amount of radioac- 
tive material that is available to private in- 
dustries and individuals not under the com- 
prehensive surveillance of the Atomic En- 
ergy Commission. The result has been that 
smaller installations, much smaller in many 
cases, have come into the radiation business. 
A more competitive situation often exists 
under these conditions, and the result is 
sometimes felt by the health protection staffs 
involved. The smaller organizations having 
licenses necessarily have smaller health 
staffs, usually with less training in the spe- 
cial field of radiation health. More and more 
general practitioners, internists, and sur- 
geons have become involved in providing 
these services, often on a part-time basis. It 
is therefore apparent that there is a need 
for greater understanding and education in 
the medical field regarding radiation haz- 
ards and the treatment of radiation injury. 

Effects of Radiation 
No medical effect of radiation is unique 
from an etiologic standpoint. Some effects, 
however, are not often associated with other 
causes. Some of the better known harmful 
effects of radiation follow. 

High dosage 

The acute radiation syndrome which fol- 
lows a short exposure to a high dose of ex- 



368 



NORTH CAROLINA MEDICAL JOURNAL 



September, 19(50 



ternal penetrating radiation of several hun- 
dred or more roentgens is well documented 
and offers little diagnostic difficulty, partic- 
ularly when there is a good history of dosage. 
The condition has been seen in patients re- 
ceiving radiation therapy, in the Japanese 
and Marshallese radiation experience, and 
in an occasional industrial accident. 

Acute erythema and chronic trophic ef- 
fects on the skin following doses of the order 
of thousands of roentgens have been known 
since shortly following the discovery of the 
x-ray. 

Some carcinogenic effects of radiation 
have been well documented. There were the 
leukemias of the early radiologists and of 
the Japanese ; the bone sarcomas of the ra- 
dium dial painters and of the patients given 
radium therapeutically during the thirties; 
the skin cancers of the early x-ray workers ; 
the liver sarcomas of patients who were 
given thorium dioxide as a contrast medium, 
and the bronchogenic cancer in miners, 
which occurred as early as the middle nine- 
teenth century but was not attributed to 
radon and its daughters until 1942. 

Cataracts have been seen occasionally, par- 
ticularly in workers with the earlier cyclo- 
tron and other high energy accelerators who 
received high doses to their lenses. Tempo- 
rary sterility has occurred in cases of high, 
acute radiation doses. In all the above cases 
the doses have been very high, in the order 
of hundreds or thousands of roentgens. 

Genetic mutations have been shown to oc- 
cur in fruit flies and in mice, and it is prob- 
able that a similar effect would occur in a 
human population, although it is not likely 
to be measurable in any practical human sit- 
uation because of statistical limitations. With 
regard to the genetic effect, it is the total 
dose of radiation to an inbreeding popula- 
tion rather than the dose to any segment or 
individual that is significant. 

In laboratory animals it has been demon- 
strated statistically that high doses of radi- 
ation have nonspecific life-shortening effects, 
but the evidence in studies on human beings 
is not conclusive. 

Low dosage 

All the above effects have resulted from 
relatively large doses of radiation. No con- 
clusive demonstration of injury from low 
doses of ionizing radiation in human beings 
has been made as yet. Our estimation of 
the effects of low closes, therefore, must be 
based on the effects of high doses. Since the 



information available is not sufficient to per- 
mit the demonstration of the threshold that 
exists for most other noxious agents, in gen- 
eral the effects of low doses have been esti- 
mated on the basis of a linear interpolation 
from the effects of high doses, which yields 
probably the most pessimistic interpretation. 

Standards 

Several groups have developed standards 
of radiation exposure that are currently in 
use in this country. In 1929 an organization 
which subsequently became known as the 
National Committee on Radiation Protection 
and Measurements (NCRP), began develop- 
ing standards of exposure based on the haz- 
ards of x-ray and radium, which were the 
main sources of radiation in those early days. 
The committee is an independent group. It 
has been expanded and diversified in the in- 
tervening years to meet industrial needs, and 
has published several handbooks which have 
proved useful in the field of radiation pro- 
tection. Currently the most widely used are 
Handbook 59, which presents standards of 
exposure to external radiation" 1 , and Hand- 
book 69, which lists standards of concentra- 
tion in air and water for some 240 radioiso- 
topes' 2 '. 

The American Standards Association 
(ASA) has developed and is developing ra- 
diation standards and codes covering several 
different phases of the nuclear industry. 

In 1959 the President and the Congress es- 
tablished the Federal Radiation Council 
(FRC), which is a cabinet-level organization 
with responsibility to " . . . advise the Presi- 
dent with respect to radiation matters, di- 
rectly or indirectly affecting health, includ- 
ing guidance for all federal agencies in the 
formulation of radiation standards and in 
the establishment and execution of programs 
of cooperation with States ..." Report No. 
1 of the FRC was issued on May 13, I960' 3 '. 

These three organizations are not in direct 
competition with each other. In general, the 
NCRP has developed primary and secondary 
standards of exposure on a broad basis, the 
ASA has written detailed codes of operation 
and measurements, and the FRC has pro- 
vided an official basis for the government 
use of radiation standards and coordinated 
application of standards at the level of fed- 
eral agencies. 

In general, the values are in agreement. 
For external exposure of the whole body to 
radiation, the occupational value is 3 



September, 1960 



RADIATION HAZARDS IN INDUSTRY— ELY 



369 



Table 1 
External Exposure of AEC Radiation Workers, 1958 



Dose in Rems 

0- 1 

1 -2 

2-3 

3-4 

4-5 

5-6 

6-7 

7-8 

8-9 

9-10 
10-11 
11-12 
12-13 
13-14 
14-15 
15 plus 



No. of Employees 

59,455 

4,041 

1,652 

407 

171 

67 

31 

27 

23 

11 

4 

1 

3 

2 



12 



rems per quarter and an average of 5 rems 
per year. For parts of the body or individ- 
ual organs, the standard of exposure is gen- 
erally higher. 

Exposures 

The actual exposures to workers in radia- 
tion from occupational sources can be seen 
in table 1, which is a tabulation of the re- 
corded external radiation doses to Atomic 
Energy Commission radiation workers for 
1958. ' 

Although this tabulation represents only 
one year's record, it is typical of the ex- 
posures of other years. It is apparent that 
the great majority of the doses were very 
low compared to the radiation standards in 
effect. All the higher doses resulted from 
accidental exposures, and only a few of those 
were above the standard of 3 rems per quar- 
ter or an average of 5 rems per year. 

In table 2 are listed most of the sources 
and approximate doses of radiation to which 



the average population is exposed currently. 
The values were derived from the Federal 
Radiation Council Report No. 1. 

Although the values are only approximate, 
the table serves to show that the dosage to 
the main population is coming from essen- 
tially two sources. The first is natural radi- 
ation, which has existed since the beginning 
of mankind. The other is medical x-ray, 
which became a factor at the turn of the cen- 
tury. It is apparent that such sources as in- 
dustrial radiation, fallout, luminous dials, 
and television sets comprise only a negli- 
gible portion of the total dosage to which the 
average population is exposed. 

Prevention 

The practice of occupational health in ra- 
diation industry is almost entirely preven- 
tive, very little being curative. Certainly 
this represents the desirable trend in occu- 
pational health in general, but the radiation 
case seems to be in the forefront of the trend. 
There have been a total of three accidental 
deaths caused by the Manhattan Engineer- 
ing District and Atomic Energy Commission 
operations, constituting about 1 per cent of 
all industrial deaths. Nonfatal radiation in- 
juries probably constitute a similarly small 
portion of the total injuries. The total inci- 
dence of injuries due to radiation and con- 
ventional hazards has been better than that 
of most other industries. 

Thus most of the practice of the industrial 
physician in a radiation industry will be con- 
ventional occupational medicine. Employees 
will continue to fall down, cut themselves, get 
burned, and become chemically intoxicated 



Table 2 

Approximate Average Annual Soft Tissue 

Radiation Dose to the Population 



Source 


Dose in Millirems 


Comment 


Natural 






External 






Cosmic rays 


32-73 




Terrestrial gamma rays 


25-75 




Internal 






Potassium-40 


19 




Carbon-14 


1.6 




Radium-226 


2-15 


Questionable values 


Man-made 


_, 




Medical (exposure to patients) 






Diagnostic x-rays 


50-100 




Therapy 


— 


Not available 


Internal radionuclides 


1-10 


Questionable values 


Occupational 


20 


High estimate 


Environs of medical and industrial 


5 


High estimate 


sources 






Fallout 


2 




Other (luminous dials, TV, etc.) 


1-3 





370 



NORTH CAROLINA .MEDICAL JOURNAL 



September, 1960 



in almost any industrial setting. The indus- 
trial physician's main responsibility regard- 
ing the radiation hazard is to assist in the 
prevention of injury and of overexposure. A 
comparatively frequent task in some circum- 
stances may be the decontamination of an 
employee — that is, the removal of radioac- 
tive material externally or, less frequently, 
internally. This procedure is really preven- 
tive in nature rather than curative, in that 
decontamination prevents the delivery of a 
radiation dose. 

Diagnosis 

The physician in a nuclear industry should 
be prepared for and expect occasional radia- 
tion injuries, and although the cases on 
which to gain experience have been few and 
far between, he should be prepared to diag- 
nose and treat the injury. He should make 
a clear distinction between a radiation dose 
and a radiation effect. They are too often 
equated. The determination of a radiation 
dose is the responsibility of an industrial hy- 
gienist or health physicist; the diagnosis of 
a radiation effect is a medical responsibility. 

Some effects are characteristic enough and 
appear promptly enough to make it easy to 
determine the cause. After a long latent per- 
iod following a low or unknown dose of radi- 
ation, however, the diagnosis, may have to 
be based on the probabilities of the situation, 
many of which are essentially unknown at 
the present time. A statement on the diag- 
nosis and compensation of radiation injury 
by the Radiation Committee and Compensa- 
tion Committee of the Industrial Medical As- 
sociation may be of interest in this connec- 
tion 141 . 

Treatment 

There is no specific treatment for radia- 
tion injury. This is not to say that there is 
no need for specific competence in the field, 
but rather that many of the familiar tech- 
niques for treating more conventional injur- 
ies are equally important in the treatment 



of those caused by radiation. The acute radi- 
ation syndrome due to exposure of the whole 
body is treated basically by the usual symp- 
tomatic and supportive measures. In very 
serious cases, bone-marrow transfusions 
have been tried, but this is still an experi- 
mental procedure. 

The treatment of radiation burns is not 
basically different from that of thermal 
burns, and the techniques of the general and 
plastic surgeon will be most useful in these 
cases. Since the delayed effects of radiation 
cannot usually be differentiated from other 
conditions, it follows that the treatment 
would not be different. 

Summary 

With the expanding uses and usefulness 
of radiation and radioactive materials in in- 
dustrial and everyday life, there will be in- 
creased need for the services of occupational 
health personnel. Injury from radiation is 
and should be a vanishing component of in- 
jury from all causes, and the practice of radi- 
ation health should be limited almost exclu- 
sively to prophylaxis. Much of the treatment 
of radiation injury is familiar from conven- 
tional medical experience, and those in the 
medical profession can, with some additional 
education in the nature of radiation and radi- 
ation hazards, contribute considerably to the 
field of industrial radiation health. 

References 

1. National Bureau of Standards Handbook 59. September 
24. 1954 (extended January 8. 1957). For sale by the 
Superintendent of Documents, Washington 25, D. C. 
Price 35 cents. 

2. National Bureau of Standards Handbook 69, June 5, 1959. 
For sale by the Superintendent of Documents, Washing- 
ton 25. D. C. Price 35 cents. 

3. Background Material for the Development of Radiation 
Protection Standards, Report No. 1 of the Federal Radia- 
tion Council, May 13. 1960. For sale by the Superintendent 
of Documents. Washington 25, D. C Price 30 cents. 

4. Statement on the Diagnosis and Compensation of Harm- 
ful Effects Arising as a Result of Work Involving Ex- 
posure to Ionizing Radiation. Statement of the Radiation 
Committee and Compensation Committee of the Industrial 
Medical Association. J. Occupational Med., in press. 



September, 1960 



371 



Physical Requirements in Textile Manufacturing 



Charles G. Gunn, Jr., M.D.* 
Winston-Salem 



Textile manufacturing has contributed 
more to the economic growth of our state 
than any other industry. In 1958, the last 
year for which we have figures, one fourth 
of the gross wages for all North Carolina 
industry (manufacturing and non-manu- 
facturing combined) was paid to textile 
workers. Forty-three per cent of the man- 
ufacturing payroll was paid to textile em- 
ployees in that year, and the chances of 
guessing the occupation of a Tar Heel in- 
dustrial worker correctly were 50-50 if you 
said, "He's in textiles."' 1 ' 

So universal a manufacturing process 
affects each of us in our practice of medi- 
cine. We care for the health of textile 
workers in virtually every county in North 
Carolina (fig. 1). Of the 24 counties with- 
out textile manufacturing, all but 4 are 
adjacent to counties with textile plants. 
These non-industrial counties, of course, 
contribute commuting employees to the 
other counties. It's a sure bet that 96 per 
cent of the members of our State Medical 
Society have treated at least one textile em- 
ployee (or his or her family) in the past 
week. 

Table 1 lists the types of textile indus- 
tries operating in North Carolina in 1958, 
with the number of employees'-'. 



Table 1 
Types of Textile Industries in 

North Carolina in 1958 
Industry No. Employees 



1. 


Yarn and thread mills 


45,800 


2. 


Knitting mills 


63,765 


3. 


Narrow woven or braided fabrics 


1,859 


4. 


Broad woven cotton fabrics 


68,477 


5. 


Broad woven cotton, 






man-made fiber and silk 


23,087 


6. 


Broad woven wool fabrics 


4,528 


7. 


Dyeing- and finishing textiles 


7,276 


8. 


Apparel and other 






finished products 


26,514 


9. 


Floor-covering mills 


900 


0. 


Miscellaneous textile goods 


3,417 



Total 



245,623 



♦Medical Director, Hanes Hosiery Mills, Winston-Sa'em, 
North Carolina. 



It is the purpose of this paper to review 
one or two typical operations in each type 
of major industry, describing by picture 
and exposition the physical requirements 
for an employee engaged in each represent- 
ative job. Where textile manufacturing 
operations are related or similar — for ex- 
ample, nos. 3, 4, 5, 6 (table 1) — one pic- 
ture and description will be used. 

From Yarn to Fabric 
Whatever the end product may be (nos. 
2 through 10) the first step has to do with 
the yarn. This may be vegetable or animal 
fiber, or man-made (synthetic). In figure 
2 a speeder tender (or roving-frame ten- 
der) is operating a machine drawing cotton 
sliver into roving, which will be reduced 



MONTHLY AVERAGE EMPLOYMENT FOR YEAR 1957 




£ C Q C H 2 
I 20. 000-J5. 000 |:||||;, 000-4.999 

I IOaVO 19.999 I 1 500 I 999 

!->:*:j 5.000-9.999 j ^1.499 

None - Unshaded 



Fig. 1. County distribution of covered employment in textiles. (Courtesy, Employment Security Com- 
mission of North Carolina.) 



::7L' 



PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN September, 1960 




Fig. 2. Speeder tender or roving frame tender. 

This speeder tender is responsible for four machines, each holding 120 bobbins of roving. He must 
constantly inspect for broken ends. He removes, or doffs, the completed bobbin and replaces it with an 
empty one. Proper humidity is essential for an efficient operation. Vision, tactile sensibility, freedom of 
motion in all joints (for reaching and lifting), and manual dexterity are considered primary in his work. 
Note the safe manner in which he carries his pneumatic roll-picker over his shoulder in the cleaning op- 
eration. 




/y 

"DOFFING THE 
TAKE -UP PACKAGE. 




Fig. 3. Fluflon operator. 

This young lady is responsible for the constant observation of more than two thousand heat cans and 
their pirns and take-up packages. She must watch for breaks in the yarn. She is walking 50 per cent 
of the time. This work requires a high degree of visual accuity, exceptional tactile sense, and a full range 
of motion in all joints. Again, humidity plays an important part in the quality of the finished product. 
Air conditioning offers a more uniform environment and product, as well as a more efficient employee. 
Fluflon, like nylon and dacron is a svnthetic vara. 



September, 1960 PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN 



373 




G 



/ COMPLETED 
( STOCKING 

(POLD DOWN') 





<? i 



Fig. 4. Knitter. 

This knitter walks along an aisle of 30 machines. He is responsible for removing the finished knit 
cylinder of the embryo stocking and inspecting it on a board, rolled along as he walks. Note the folding 
step to permit adjustments and threading at the top of the machine. Full shoulder and knee motion 
is a prerequisite for this operation, as is excellent manual dexterity and a mechanical aptitude. Note the 
pans under the machines to retain oil and prevent spread to the aisle. 



even more in diameter by a similar opera- 
tion before knitting (or weaving) takes 
place. 

The chemical or thermal treatment of 
yarn prior to use gives it unusual charac- 
teristics. In figure 3 a fluflon operator is 
taking off (doffing) a take-up package up- 
on its completion. The yarn has coursed 
from the pirn through a heat can while un- 
der a fixed amount of twisting and tension 
to give it recoil or springy properties, and 
upward again to the take-off package. 

The two operations that put the yarn or 
thread, whether of natural or man-made 
fiber, into fabric are either knitting or 
weaving or a combination of the two. 

Most knitting is of the circular variety — 
that is, the knit material forms a cylinder. 
The diameter of this cylinder may vary 
from y% inch to 36 inches, depending upon 
the product being manufactured. In figure 
4 a knitter in a seamless hosiery mill can 
be seen checking a stocking from a knit- 
ting machine. This machine has the same 
basic design as one knitting wider and 
heavier materials. 



Weaving, the major industrial use of 
yarns in addition to knitting, can be divided 
into broad and narrow woven products. An 
example of a broad woven product is bed 
sheeting ; of a narrow woven product, cloth 
tape. 

In either process, the loom must be sup- 
plied with warp. In figure 5 a worker is 
seen inspecting the transfer of yarn from 
hundreds of packages or cheeses, on a rack 
called a creel, to the wide cylinder in the 
warper called the beam. The beam is then 
transferred to the loom (See fig. 6). 

The beam furnishes the warp, whether 
the loom is a narrow-fabric machine or a 
broad loom. In figure 6 a narrow-fabric 
machine or loom is seen. The warp ends are 
brought up from the beam and down to the 
harness, where they emerge to meet the 
shuttles carrying the cross threads or fill- 
ing ends. The principle involved in the 
broad loom is the same. Instead of many 
small shuttles and the resulting narrow 
tapes, one large shuttle is used, making a 
wide roll of cloth, or cut. 



374 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 




Fig. 5. Warper. 

'Phis operator is observing the transfer of yarns 
from the creel to the beam in a warper. He must 
possess a high degree of visual accuity and depth 
perception, an experienced tactile sense to piece 
ends together, and a stable back to remain at po- 
sitions of slight flexion in performing his work. 
(Courtesy, Employment Security Commission of 
North Carolina.) 



Fin ish ing Operations 

We come now to the finishing or com- 
pletion operations of the textile product. 
One of these, performed by thousands of tex- 
tile employees each day, is looping. This is 
the closing of the toe in the stockings, men's 
socks, children's socks, doll socks, and so 
forth, when the sock has been knit as a 
cylinder of fabric open at both ends (fig. 
4 ) . This work may be done prior to dyeing, 
or it may be performed on socks knit with 
yarn that is pre-dyed. The looping dial is 
built to mate the knitting needle intervals, 
and may have points ranging from 12 per 
inch to 40 per inch (fig. 7). 

Whether fabric for the lining of your 
next suit or fabric for your next car or 
your child's pajamas, the woven and knit 
fabrics must be put in an attractive, useful, 
durable form. 

Treatment of fabrics by chemicals and 
heat play an important role in this condi- 
tioning. In finishing mills large vats or 
tanks called kiers are filled with hundreds 
of feet of woven material. This material 
is steeped with chemicals or enzymes for 
varying periods of time, then emptied by 
power equipment for washing and further 



dyeing and finishing 
momentary repair of 
of a fabric coming 
washer. 

The final dyeing of 
yarns is accomplished 



Figure 8 shows the 
a break in the strand 
from a kier to the 



fabrics as well as 
by the addition of 




r 

Finished 

WOVEN 

NARROW 
FABRIC 




LOOM ARCH 



-HARNESS 



Filling ends 

FROM QUILLS 
ONE TO EACH-' 
SHUTTLE 



Fig. 6. Weaver. 

This man is responsible for three looms. His main activity is walking, moving constantly between the 
machines to inspect the operation, repairing ends when breaks occur in both the warp and the filling ends. 
Visual acuity of a high degree is essential, as is a normal tactile sense in the fingers. Excellent range 
of motion in all joints assures easy operation of the loom. Back flexion is extremely important for the 
requirements of reaching the warp ends. Lifting is minimal in this operation. Most weaving does not re- 
quire the weaver to remove or doff the finished take-up reel or cut. This operation is assigned to other 
employees. 



September, 1960 PHYSICAL FACTORS IN TEXTILE INDUSTRIES— GUNN 375 

LAMP 
fp==J 

LOOP 





Fi^. 7. Lcoper. 

This operation — placing the stocking or sock on its "points" in the only correct position — is extremely 
delicate and exacting. The dial revolves (here clockwise) slowly while the fabric is applied. The final 
stitching and cutting of the now useless loop from the foot of the stocking is accomplished by mechan- 
ical means as it makes its tour around the dial, until the operator removes the stocking, completed, in 
front of her. 

This work is done in a sitting position. It requires a high degree of visual acuity with an accompany- 
ing ability to converge easily (esophoria) and excellent depth perception. Tactile sensibility is of great 
importance. Emotional stability must be considered in any list of prerequisites. 





MERROvd i] 

CO(J WHEELS) J~" 



FROM THE 

BLEACHING 

KIER. 



Fig. 8. Kier Boiler. 

The textile worker, on the right, a kier boiler, weighs bleaching chemicals and by virture of the opera- 
tion, works in an atmosphere of higher humidity and heat than that generally prevailing throughout the 
plant. The skin of these workers should be free of recurring infections and free of hypersensitivity to 
foreign materials. Strong muscles and a stable back are essential to the effective operation of the lid on 
the kier tank and to turning the large valves in the piping system. 



dyestuffs to water at high temperatures. 
This creates an environment similar to that 
of the bleaching operation just described. 
Figure 9 shows a piece-dye kettle operator 
beside his machine in a broad woven fabric 
mill during a dye run. 

Comment 

Here, in summary, is a view of textile 
manufacturing from yarn to finished fab- 
ric. No summary would be complete with- 



out the final step: apparel manufacturing. 
In order to prevent raveling of the cut ma- 
terial, an overedger or serger applies, by 
machine, a whipped stitch. This operation 
is performed before the garment is assem- 
bled on a sewing machine (fig. 10). 

Summary 

A brief description of textile manufac- 
turing and the work requirements of repre- 



37C 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 




CYLINDER 



^-MOVABLE 
I / DOOR. 

' 4+UKAPS' 




Fig. 9. Piece Dye Kettle Operator. 

The taffy-like strands are long segments of 80 yards rolled over a reel and rotated at medium speed 
through the dye bathe. The operator is responsible for four machines, for measuring the chemicals 
placed in each load, for placing the cloth on the reel, and keeping records of each lot. Note that he is 
wearing shoe covers for protection from the moisture normally present in such operations. 




Fig. 10. Sergers (Overedgers). 

Sergers, or overedgers, overcast the raw edge 
of cloth to prevent raveling. This is a job re- 
quiring good manipulative ability, agility of hands 
and fingers, good visual acuity, and, as with loop- 
ing, emotional stability. (Courtesy, Employment 
Security Commission of North Carolina.) 



sentative jobs in this industry has been pre- 
sented. It is hoped that this will create ad- 
ditional understanding of the textile indus- 
try and of the work performed by our pa- 
tients in this industry. 

Acknowledgements 

Grateful acknowledgement in the preparation of 
this paper is to be given to Dr. William Wilson, 
Occupational Health Section, State Board of 
Health, Raleigh, N. C; Mr. Ted Davis, Employ- 
ment Security Commission, Raleigh, N. C; Dr. 
J. M. Hall, Elkin, N. C; Dr. Ben Pulliam, Mr. 
Arnold Aspden, Mr. C. Zell Taylor and Mr. H. C. 
Woodall, Jr., all of Winston-Salem. 

References 

1. The Employment Security Commission, Quarterly, Winter- 
Spring, 1959. 

2. North Carolina Employment and Wages 195N, Employ- 
ment Security Commission of North Carolina. August, 
1959. 



September, 1960 

The Governor's Council on Occupational Health 

A Medium of Cooperative Effort for the Health of the Worker 



377 



William P. Richardson, 
Chapel Hill 



.D. 



In every period medicine has to face the 
problem of a twofold adaptation. On the one 
hand it must adjust to changes and develop- 
ments in the social and economic order, and 
on the other hand it must find new ap- 
proaches and methods for making available 
new or improved medical services which have 
been made possible through scientific and 
technological advances. It is customary for 
each generation to think its problems and de- 
velopments are the greatest of any period of 
history, and we in the mid-twentieth century 
are no exception. Whether or not this is 
really true, it cannot be denied that the pace 
of the developments, both social and scien- 
tific, to which we must adapt is more rapid 
than in previous periods and that it is pick- 
ing up speed all the time. With the accele- 
rated pace of change it becomes increasingly 
difficult and increasingly important to de- 
velop sound modes of adaptation which pre- 
serve the enduring values and principles that 
have always guided our profession. 

One of the unique characteristics of the 
changes of the past few decades has been 
the fact that they brought into the picture of 
medical care and medical service not only 
many professional workers other than phy- 
sicians, but also a variety of agencies and 
institutions. This is making it necessary for 
the physician to develop a whole new set of 
relationships, and to learn to carry out many 
of his functions on a cooperative basis with 
the various members of what is often called 
the "health team," with hospitals, and with 
those organizations and agencies which we 
have termed third parties. 

Occupational health programs, as they 
have evolved and continue to evolve, repre- 
sent an adaptation to the special needs cre- 
ated by expanded industrialization, which 
has concentrated workers into large groups 
and exposed them to the hazards of increas- 
ingly complex technical procedures and a 
rapidly growing assortment of new and un- 



*Read before the Section on General Practice of Medicine, 
Medical Society of the State of North Carolina, Raleigh, May 
11, 1960. 

From the Department of Preventive Medicine, University of 
North Carolina School of Medicine, Chapel Hill. 



familiar chemical and physical agents. The 
presently accepted pattern of occupational 
health programs is an achievement in which 
both the medical profession and our indus- 
trial society can take genuine pride. Its de- 
velopment has not been easy. There have 
been difficulties, differences of opinion and 
controversy, but after all that is the way 
most worthwhile achievements are made. The 
significant thing is that we have developed 
a philosophy, a set of principles, and a pro- 
gram which have met with the official ap- 
proval of organized medicine and of the busi- 
ness and industrial community, and which, 
as understanding of them spreads, are gain- 
ing the warm support of the rank and file of 
both groups. 

The other speakers are dealing with the 
way occupational health programs are or- 
ganized and operate, and the services they 
provide. The feature of these programs I 
would like to stress, because it forms the 
basis for the whole idea of an occupational 
heath council, is the number of individuals 
and agencies involved in protecting and pro- 
moting the health of the worker, and the re- 
sulting importance of close, cooperative rela- 
tionships among them, based on principles 
and objectives understood and accepted by 
all parties of the program. 

Growth of the Occupational Health 
Movement in North Carolina 

Those of us who have been close to de- 
velopments in occupational health in North 
Carolina feel that significant and heartening 
progress has been made over the past several 
years. A very important beginning was made 
when several able, highly intelligent, and 
enthusiastic young men entered this field of 
practice in the state, and no account of de- 
velopments would be complete without tri- 
bute to the splendid contributions these men 
have made by their enthusiastic demonstra- 
tion and promotion of what constitutes good 
occupational health practice and what it can 
accomplish. 

While the state medical society has had 
a committee in the field of industrial 
health since 1934, it was primarily con- 



378 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



cerned with problems referred to it, in 
the main related to the Industrial Com 
mission. The first special effort by the so- 
ciety to stimulate interest and understanding 
in this field was an industrial health seminar 
held at Chapel Hill in February, 1954, spon- 
sored jointly by the University of North 
Carolina School of Medicine and the society's 
Committee on Industrial Health under the 
leadership of Dr. Harry L. Johnson. This 
seminar became an annual event, and in sub- 
sequent years was expanded to include a half 
day devoted to subjects of interest to repre- 
sentatives of business and industry and of- 
ficials of state agencies having responsibili- 
ties related to industrial health and safety, 
as well as to physicians. 

Out of these expanded seminars grew the 
suggestions for a state conference on occu- 
pational health sponsored by Governor 
Hodges, and bringing together all who might 
have interest or responsibilities in the field : 
physicians, nurses, engineers, public health 
workers, officials, legislators, and as wide a 
representation as possible from business and 
industry in the state. The first Governor's 
Conference on Occupational Health was held 
in January, 1957, and those attending ap- 
proved a strong recommendation for a per- 
manent council on which all the interested 
professions and groups would be represented. 
As a result of this recommendation and of 
Governor Hodges' interest and support, a 
steering group was formed to plan an or- 
ganizational meeting and to lay the ground- 
work for selection of members. This group 
was composed of the Committee on Occupa- 
tional Health of the State Medical Society, 
representatives of the State Board of Health, 
the Department of Labor, the Industrial 
Commission, the Vocational Rehabilitation 
Division of the Department of Public In- 
struction, the University of North Carolina 
Schools of Medicine and Public Health, and 
two invited representatives from industry. 

The preliminary planning took almost a 
year and a half. Largely from a list of names 
suggested by the steering group. Governor 
Hodges asked 42 people to serve on the Coun- 
cil. In making the appointments, representa- 
tion was provided from the medical, nursing 
and engineering professions, from the vari- 
ous state agencies concerned, from labor, and 
from a cross section of business and industry 
in the state, including large and small busi- 
ness and all the major industrial and busi- 



ness fields. An enthusiastic organizational 
meeting was held in July, 1958. The present 
membership is 44, including 13 physicians. 
This number will be enlarged somewhat in 
the near future as a result of action taken 
at the last meeting of the Council to add rep- 
resentation from the dental profession, the 
Department of Agriculture, and the Agricul- 
tural Extension Service. 

Objectives and Functions of the Council 

You will be interested in the objectives of 
the Council as stated in the by-laws. These 
are: 

1. To promote interest in all phases of 
employee and worker health in North 
Carolina. 

2. To provide an effective means for co- 
operation and interchange of informa- 
mation among all the agencies and 
groups interested in the problems. 

3. To promote study of special hazards to 
employee health which may exist in 
North Carolina. 

4. To promote the development of practi- 
cal programs by which small business 
and industrial establishments and ag- 
ricultural employers may provide 
health services for their employees. 

5. To interpret to the officials and citizens 
of the state the needs and accomplish- 
ments in the occupational health field 
in North Carolina. 

6. To sponsor an annual Governor's con- 
ference on occupational health. 

Perhaps the most significant function of 
the Council, as distinguished from its over- 
all objective of promoting the health of work- 
ers, is indicated by the second objective, that 
of providing an effective means for coopera- 
tion and interchange of information among 
all who have a concern for and a part in the 
protection and promotion of worker health. 
Physicians and nurses, of course, have a tra- 
dition of working together, but heretofore 
there has been too little opportunity to de- 
velop mutual understanding between busi- 
ness and industrial management and the 
health professions, between physicians and 
safety engineers, or between all of these 
groups and the several official agencies con- 
cerned with industrial health and safety. The 
Council supplies a medium where these 



September, 1960 



OCCUPATIONAL HEALTH COUNCIL— RICHARDSON 



379 



groups can come together and become fa- 
miliar with each other's points of view and 
problems and can direct their efforts toward 
the development of more effective coopera- 
tion in promoting the health of the working 
population. 

The establishment of such a forum for 
communication and exchange of ideas is in 
itself a significant development. As society 
gets more complex, the problem of commun- 
ication between various groups which may 
impinge on each other becomes increasingly 
difficult. The Council with its broad repre- 
sentation provides a forum where thought- 
ful consideration can be given to the prob- 
lems and ideas of each group, and some mu- 
tual understandings achieved. Through the 
annual Governor's Conference we have a 
broader forum, since the conference is open 
to all, and aims for a large and representa- 
tive attendance. 



Current Projects 

Handbook on occupational health 

Because the Council is new we have no 
completed accomplishments to report, but 
two of the projects presently under way are 
of particular interest to this group. The first 
is a North Carolina handbook on occupa- 
tional health. This should be a valuable 
source of information for all concerned with 
the subject, but especially for physicians do- 
ing part-time industrial practice, and for 
management, which wants to know what 
legal requirements it must meet, to what 
sources it can turn for consultation and help, 
and what are approved patterns of health 
services for employees. It should also be of 
significant interest to industrial and business 
concerns considering locating in North Caro- 
lina. It will, of course, be given wide distri- 
bution. Most of the material has been assem- 
bled, and it is hoped the completed handbook 
will be available by the time the Annual Con- 
gress on Industrial Health of the A.M. A, 
meets in Charlotte in October. 

Services to small plants 

The second project is a study of possible 
means of providing health services to em- 
ployees of establishments too small to have 
any kind of full-time service of their own. 
Occupational health programs are being de- 
veloped by an increasing number of large 



industries, but approximately 9 1 per cent of 
North Carolina establishments have fewer 
than 500 employees, and nearly 80 per cent 
have 100 or fewer employees. It is clear, 
therefore, that if the majority of our state's 
workers are to have the benefits of such serv- 
ices, some plan for providing them other 
than the conventional in-plant medical de- 
partment will have to be devised. It is equally 
clear that any effective plan, generally ap- 
plied, will involve participation by most of 
the general practitioners of the state devot- 
ing some time to occupational practice. 

As you perhaps know, there are a number 
of so-called small plant services which have 
attracted considerable attention. We have 
had people from some of them talk at our 
Governor's Conference. These services are 
excellent, and represent imaginative solu- 
tions of particular situations. The trouble 
is, the establishments they serve, while meas- 
ured in hundreds of employees rather than 
thousands, are still much larger than those 
which constitute the largest segment of our 
need in North Carolina. It is worth noting 
that the health hazards and problems in 
small establishments are proportionately 
greater than those in larger ones. Coming 
up with a practical approach to this need 
is one of the challenges we face, and it is 
one to which the Council is addressing itself. 

Conclusion 

We may summarize this discussion with 
four points which I think deserve emphasis : 

1. The formation of the Governor's Coun- 
cil on Occupational Health is but the most 
recent in a succession of developments mark- 
ing the growth of appreciation for and in- 
terest in employee health services in North 
Carolina. 

2. The Council offers an excellent medium 
for communication and cooperation among 
all those concerned with this field. 

3. It is inaugurating activities which 
should make significant contributions to fur- 
ther progress. 

4. The ultimate success of the Council and 
the solution of the problem of occupational 
health services for the majority of our state's 
workers will require the understanding, in- 
terest, and participation of the practicing 
physicians of the state. 



::xu 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Clinical Evaluation of the Antacid Properties 
of Hydrated Magnesium Aluminate 



David Cayer, M.D. 

and 

M. Frank Sohmer, M.D. 

Winston-Salem 



Benign peptic ulcers do not occur in pa- 
tients with permanent achlorhydria. In those 
patients having active duodenal ulcers, gas- 
tric hypersecretion is invariably present. 
The relationship between ulcer and acid is 
well established, although no definite corre- 
lation between the degree of acidity, the se- 
verity of ulcer symptoms, and ulcer activity 
has been demonstrated. Clinically, antacid 
agents provide symptomatic relief. 

General Principles of Antacid Therapy 

The efficacy of an antacid depends upon 
(1) the quantity of acid bound, (2) the 
speed of buffering, (3) the duration of ac- 
tion, and (4) the rate of gastric emptying. 
The effect of acid-neutralizing drugs on gas- 
tric secretions is also influenced by (1) the 
amount of drug administered, (2) the phase 
of digestion, and (3) the presence or ab- 
sence of disease. 

Free acid, usually defined as being present 
at pH levels below 2.8, is considered respon- 
sible for the digestive effect of gastric juice. 
At pH levels above 2.8 the proteolytic ac- 
tivity of pepsin is greatly reduced. A pH 
in the range of 3.5 to 5.5 is regarded as 
favorable for ulcer healing. Levels above 
pH 7 may lead to "rebound" stimulation of 
gastric secretion, and are generally consid- 
ered undesirable. 

The ideal antacid preparation would be 
one that is nonirritating and can be used in 
small doses to neutralize large amounts of 
gastric juice promptly and for prolonged 
periods. It should not cause systemic alka- 
losis, produce a rebound stimulation of acid 
secretion, interfere with digestive processes, 
induce diarrhea or constipation, nor release 
carbon diovide on reacting with hydrochloric 
acid. 



Studies of Hi/drated Magnesium Aluminate 
We have recently studied a new type of 
antacid produced by the chemical union of 
aluminum hydroxide and magnesium hydrox- 
ide, two of the most widely used antacids. 
The resulting compounds, hydrated magne- 
sium aluminate*, is a uniform, stable white 
powder, which can be prepared both as a 
tablet and as a gel. 

In vitro studies 

In contrast to the previously described 
magnesium aluminates in which the ratio of 
magnesium to aluminum is always 1 :2, hy- 
drated magnesium aluminate has a magne- 
sium-aluminum-water ratio of 4:2:9. The 
in vitro action of this complex differs mark- 
edly from that of equivalent physical mix- 
tures of magnesium and aluminum hydrox- 
ide, producing more favorable, less scattered 
pH values within the therapeutically desired 
range of 3.5 to 5.5, and maintaining such 
levels for 40 to 60 minutes (fig. 1). The 
use of an equivalent physical mixture of mag- 
nesium and aluminum hydroxide produces 
widely scattered pH values outside the thera- 
peutically desirable range, with less sus- 
tained buffering action. 

The magnesium aluminate hydrate reacts 
promptly with gastric hydrochloric acid to 
form aluminum hydrochloride gel and mag- 
nesium chloride, each with an acid-binding 
effect. 

The relative acid-combining capacities! of 
hydrated magnesium aluminate and other 
antacids, in terms of the amount of 0.1 nor- 
mal hydrochloric acid neutralized per gram, 
are as follows : 



U.S. P. aluminum hydroxide (dry gel) 
Magnesium aluminate hydrate 
Dihydroxy aluminum sodium carbonate 
Magnesium trisilicate 
Sodium bicarbonate 



254 cc. 

247 cc. 

238 cc. 

140 cc. 

120 cc. 



From the Department of Medicine of the Bowman Gray 
School of Medicine of Wake Forest College, Winston-Salem. 
North Carolina. 



'Supplied as Riopan (400 mg, tablets) through the cour- 
tesy of Ayerst Laboratories. 

■ Determined by stirring aliquots of the substance with ex- 
cess 0.1 normal hydrochloric acid at 37 C. for one hour, 
and back titrating the excess acid. 



September, 1960 HYDRATED MAGNESIUM ALUMINATE— CAYER AND SOHMER 



3S1 



Effect of the Maximum Recommended Dosage on the pH of 100 cc N/100 HCI. 
(tablets added as an 80 mesh pomder) 
70r 




7.--*""' 



pH 4 -j 



10 20 40 



60 90 120 

TIME (Seconds) 



I. Aluminum hydroxide gel with magnesium hydroxide - 2 Tablets 

2. Aluminum hydroxide gel - 2 Tablets 

3. Aluminum hydroxide gel (4 grains) and magnesium trisilicate 

(7 1 /, groins) - 2 Tablets 

4. Magnesium and aluminum hydroxide - 4 Tablevs 

5. Reactive aluminum hydroxide - 4 Tablets 

6. — Hydraled magnesium aluminate (AY-5710, "RIOPAN'1-400 mg/ 

tablet -4 Tablets 

7. Magnesium trisilicate, calcium carbonate and magnesium 

hydroxide - 4 Tablets 

6. Calcium carbonate prec, magnesium carbonate and mognesium 

trisilicate -4 Tablets 

Figure 1 

The acid-combining capacity and speed of 
action of hydrated magnesium aluminate are 
compared with those of other antacids in 
figure 1. It can be seen that the hydrated 
magnesium aluminate caused a rapid eleva- 
tion of pH levels above 3, and sustained buf- 
fering capacity. 

In vivo studies 

Studies of gastric acidity were made on 
10 patients — 9 men and 1 woman — with ac- 
tive duodenal ulcers. All had evidence of 
gastric hypersecretion, and most of the 
initial acid values were in the upper range 
of normal (figure 2). 

In 4 patients who received 2 tablets of 
magnesium aluminate hydrate, buffering ac- 
tion was demonstrable for 45 to 90 minutes. 
Six patients were given 4 tablets in a single 
dose. In these patients, a buffering effect 
was demonstrable for periods ranging from 
30 to 120 minutes. 

In 4 patients specimens of gastric secre- 
tion were taken 15 minutes after administra- 
tion of 2 tablets of the drug. In one patient 
no buffering effect was demonstrable, but in 
the other 3 achlorhydria was present. 

In the majority of patients effective buf- 
fering was present for one to two hours. In 
those patients having pain at the time the 
tablets were administered, relief was prompt 
and sustained. The average pH determina- 
tions of gastric specimens are shown in 
figure 2. 



Average 

7.0 

6.0 

5.0 
4 
3.0 
2.0 
1.0 



Ph. Value of Gastric Juice in 10 Peptic Ulcer Patients 



Before 400 mq. hydraled magnesium aluminate 

After ■' ' 


o" 




/ """^x 


is Jri! 

s '" > 
1 ~ 


- 


1 


• 


I* 

? 




i i i i i i 







90 



15 30 45 60 75 

TIME (Minutes) 

Figure 2 

Clinical study 

The clinical study was conducted in 72 
patients — 55 men and 17 women — with 
symptoms of peptic ulcer. The diagnoses in 
this group were as follows: duodenal ulcer 
(63), channel ulcer (1), marginal ulcer (3), 
duodenal and gastric ulcers (1), duodenitis 
(1), normal roentgenogram (2), normal 
roentgenogram but with past history of ulcer 
(1). The patients ranged in age from 20 to 
72 years, with a mean age of 45. Twenty-five 
patients had a past history of hemorrhage. 
Six patients had previously required surgery 
for perforation or obstruction. 

Each patient had had peptic ulcer activity 
— as indicated by the history, roentgen find- 
ings, or both — within six months preceding 
the study. Fifty-three of the patients were 
considered to have clinically active ulcers at 
the beginning of the study. The duration, 
frequency, and severity of ulcer symptoms 
were determined at the beginning of treat- 
ment. The symptoms were considered mild 
in 32 patients, moderate in 26, and severe 
in 14. 

The medication used in the study consisted 
of 2 tablets of hydrated magnesium alumi- 
nate given two hours after each meal and at 
bedtime. All patients were seen at intervals 
of four to six weeks, and in the majority 
roentgen examinations were made at the be- 
ginning and at the termination of the study, 
one year later. 

Final evaluation of results was based on 
data recorded by patients and on the clinical 
impression of the investigator at each fol- 
low-up visit. The results were classified as 



382 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



"good to excellent" (freedom from ulcer dis- 
tress throughout the period of observation, 
or improvement in spite of recurrence) or 
"fair to poor" (exacerbation, no change, or 
only slight improvement with continued re- 
currences). Recurrences were classified as 
"none," "fewer and milder," "same or more." 

Results: Seven patients discontinued the 
drug — 4 because they were asymptomatic, 
and 3 because they were unimproved. Two 
other patients had a recurrence of ulcer 
symptoms after they ran out of the drug. 
The only adverse effect noted was mild con- 
stipation in 2 cases. None of the patients 
who discontinued the medication considered 
side effects a deterrent to therapy. 

Forty-nine of the patients (68 per cent) 
had good to excellent results (no recur- 
rences in 35 per cent, fewer or milder recur- 
rences in 33 per cent), while 32 per cent 
were unchanged or worse. Two patients had 
hemorrhages while under treatment, and 2 
required gastric resections. 

Comment 

lu the clinical study of 72 patients, no evi- 
dence of absorption of the hydrated magne- 
sium aluminate was noted in any case. There 
was no clinical evidence of alkalosis, disturb- 



ance of electrolyte balance, severe constipa- 
tion, catharsis, or any other significant side 

effects. 

The preparation was demonstrated both 
-'// rira and in vitro to dh o!\ ■ ra idly — 
within 15 minutes in human patients. This 
compound was able to buffer lai amounts 
of gastric acid rapidly, and in most patients 
to sustain the pH of the stomach at levels 
between 3 and 5 for approximately 60 min- 
utes. This buffering effect was manifested 
( linically by prompt relief of pain. At no 
time did the pH values rise to alkaline levels. 

Summary 

Clinical and laboratory studies with hy- 
drated magnesium aluminate indicate the 
compound to be a potent antacid which 
rapidly raises the pH of the gastric contents 
to therapeutically desired levels, which are 
sustained for periods of an hour or more. 

In a clinical study of 72 patients with 
symptoms of peptic ulcer, no evidence of ab- 
sorption, alkalosis, or disturbance of electro- 
lyte balance was noted. In the dosage used, 
the compound did not interfere with diges- 
tion, and produced virtually no side effects. 
Results were considered "good to excellent" 
in 68 per cent of the cases. 



Mail Order Prescription Services 



H. C. McAllister* 
Chapel Hill 



The deceptive lure of "price discounts" 
has been the bait with which many a trap 
has been set. The latest of these is the mail 
order prescription services which have been 
springing up here and there during recent 
months. The development of these unortho- 
dox schemes of supplying medication seems 
to have resulted from a series of circum- 
stances. 

What is believed to be the first plan to 
offer prescription service by mail is that de- 
veloped by the National Association of Re- 
tired Teachers and the American Association 
of Retired Persons. These two organizations 
worked out an arrangement with a local 
New York chain drug store group to set up 
outlets for their members. Two mail order 



From the Institute of Pharmacy. Chapel Hill. 
•Secretary-Treasurer of the North Carolina Board of Phar- 
macy. 



depots were established — one in Washington, 
D. C, and the other in California. The lat- 
ter was later closed. (It is understood that 
it failed to meet the requirements of the 
California law.) Another outlet has been 
established by this group in St. Petersburg, 
Florida. 

As a result of the newspaper headlines 
stemming from the reckless and misleading 
information (more properly misinforma- 
tion) coming out of the Kefauver Commit- 
tee hearings, other independent mail order 
prescription services have sprung up in Kan- 
sas City, Missouri; Brooklyn, New York; 
Seagoville, Texas. Another organizational 
service (Bakery and Confection Workers 
Union) has been established in Washington, 
D. C. The last mentioned has already been 
in municipal court for a hearing resulting 
from alleged failure to comply with pharm- 



September, 1960 



MAIL ORDER PRESCRIPTION SERVICES— MCALLISTER 



383 



acy, sanitation, and fire laws. At least one 
inquiry has been received by the Board of 
Pharmacy concerning' a proposed outlet in 
North Carolina. Others will doubtless be es- 
tablished in order to capitalize on the favor- 
able atmosphere created for them by the 
false and misleading information that is cur- 
rently being spread abroad about drug prices. 

Dangers and Disadvantages 

Physicians want to see that their patients 
get medication as economically as is consis- 
tent with good quality. It is only proper that 
they should. Economy, however, is not the 
only consideration that must be taken into 
account in the treatment of illness by the use 
of drugs. The time element and the assur- 
ance of proper handling are, in most cases, 
considerably more important to the physician 
and the patient than the spurious "savings" 
(which, if any, are small) that might be of- 
fered by the mail order mechanism. From 
the standpoint of the physician — and the pa- 
tient — the mail order prescription schemes 
have some serious disadvantages about which 
he — and his patient — should be informed. 

Unavoidable delays 

The present-day physician is not only bet- 
ter equipped to diagnose and prescribe than 
ever before, but he also has eminently better 
medicinal agents to meet his needs than has 
ever been the case in the past. These factors 
add up to efficient and effective treatment, 
as proved by the dramatic reduction in the 
average duration of most illnesses. To 
achieve this result, however, the physician 
must be able to administer the remedy indi- 
cated at the time of diagnosis — not days or 
weeks later, when complicating factors may 
have intervened, quite possibly altering the 
entire rationale of treatment. Allowing for 
transportation (both ways), filling, ship- 
ping, and so forth, the very minimum time 
in which a prescription can be serviced in 
Washington, D. C, from a place as near as 
North Carolina is three days. Persons who 
have used this service place the time element 
from ten days to two weeks. One cardiac 
patient requested the return of her prescrip- 
tion when the medication had not been re- 
ceived in two weeks. 

Translating the cost of the minimum de- 
lay of three days into terms of any savings 
that might be effected, it is still false econ- 
omy for the patient. Herein lies the "trap" 



of the whole mail order scheme. Inherent 
in the lure of price discounts for prescrip- 
tion service is the idea that traditional pre- 
scription services are rendered at a premium 
price. It is believed that, in general, physi- 
cians consider prescription prices fair. This 
is not as well understood, however, by some 
of their patients. 

A further consideration arising from the 
delay in the delivery of the preparation is 
the encouragement of self-medication. Pend- 
ing arrival of the prescribed drug, the pa- 
tient has a strong urge to treat himself. Here 
again is introduced an element of interfer- 
ence with the physician's plan of treatment 

Forged prescriptions 

A serious problem encountered with the 
supply of drugs through the mails is the 
verification of prescriptions. There is no way 
whereby prescriptions can be authenticated. 
As a test, several forged prescription for 
large quantities of barbiturates and central 
nervous system stimulants were forwarded 
to one of these outlets. In due time the drugs 
arrived along with a solicitation of future 
business. Such laxity in handling prescrip- 
tions and dangerous drugs not only provides 
a made-to-order opportunity for deviators to 
obtain drugs for illicit traffic, but also can 
prove troublesome for the physician in the 
management of patients with emotional 
problems and others who have the "medicine 
habit." 

Limited service 

With the wide variety of medicinal prep- 
arations available today, doctors' prescrip- 
tions require less compounding than they did 
in former years. There are occasions, how- 
ever, when compounding is necessary. Such 
prescriptions sent to the mail order outlets 
have been returned marked "not stocked." 

Suspicion was aroused when it was noted 
that the order form of one mail-order outlet 
bore an entry for the customer to indicate 
whether he wanted his prescription filled 
with the organization's "generic equivalent" 
of the drug ordered, on the assumption that 
this substitute would be cheaper than the 
genuine article. This indicates that the mail 
order company is willing to substitute its 
judgment in determining the brand of drug 
supplied for that of the doctor who ordered 
it. Evidently this item became troublesome, 
since it has now been dropped from the order 



384 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



form. One continues to wonder, however, if 
a specified brand drug will be furnished or 
whether the prescription will be filled with a 
so-called "generic equivalent" of undeter- 
mined origin. 

There is yet other evidence of the limited 
service performed by the mail order com- 
panies. A prescription calling for 30 tablets 
of a drug and marked with two refill authori- 
zations was filled with the manufacturer's 
original bottle of 100 tablets and returned 
with the explanation that they were "cheaper 
by the hundred." 

Inaccessibility of prescription files 

What is perhaps one of the most dangerous 
aspects of a mail order prescription service 
is the inaccessability of prescription files for 
use during emergencies resulting from idio- 
syncrasies or the accidental ingestion of 
drugs by persons other than those for whom 
they were prescribed. No one knows better 
than the physician how essential it is to 
identify the drug that little Johnnie drank 
while mother's back was turned. Time is of 
the essence in determining whether extreme 
measures shall be taken, as in the case of 
potent drugs, or whether simple procedures 
and assurances to the mother are adequate, 
as in the case of the less potent preparations. 
Then there is, of course, the occasional ana- 
phylactic reaction wherein the identification 
of the antigen is essential or will materially 
assist in proper treatment. 

Question of Legality 

There is a serious question as to whether 
the mail order distribution of drugs is a legal 
operation. Individual states have the right 



to exercise police power for the protection 
of the health, safety, welfare, and morals of 
their citizens. It is through the use of this 
power that the health professions are regu- 
lated. The states have exclusive jurisdiction 
over matters of professional practice and 
privilege. Neither the federal government 
nor any other extraterritorial body can or 
does confer professional license and privilege 
upon a person within a state. State laws re- 
lating to professional practice and privilege 
are administered by specialized boards or 
agencies. These boards exercise jurisdiction 
only within their own state. Their activities 
are designed to protect the people in that 
particular state against ignorance and in- 
competency. Similarly, a professional license 
in one state does not entitle the holder to 
practice elsewhere. 

This situation poses the question of 
whether or not the mail order mechanism 
constitutes the practice of pharmacy in 
North Carolina. Certainly the Board of 
Pharmacy cannot inspect these outlets to de- 
termine whether pharmaceutical services are 
being performed by qualified persons or 
whether other requirements of North Caro- 
lina law are being met. The distributors hold 
no professional license in the state against 
which the Board might proceed, nor are they 
available, without extradition proceedings, 
for other disciplinary actions as are prac- 
titioners in North Carolina against whom the 
Board can and does proceed. This aspect 
of the problem is currently receiving study 
by the Board. Until the question is resolved, 
it is believed that physicians will want to 
keep in mind the dangers associated with 
the mail order schemes, and to advise their 
patients accordingly. 



The therapist should be a good listener. Even more important, he 
should have some knowledge of semantics and should reveal to the pa- 
tient that he is interested in what the patient is saying. He should be- 
tray it in his manner and his personal expression as well as in what he 
says after the patient has expressed his opinion. Remember that a re- 
ceptive ear receives the richest harvest. As a listener, the physician in- 
creases his knowledge of human nature, and he adds to his own store 
of cultural refinements. He will find that in enabling his patient to talk 
of interests other than personal aches and worries, he has effected the 
best therapv possible. — Martin, A. R. : Recreational Measures and Their 
Value to Older People, J. Am. Geriatrics Soc. 7:536 (July) 1959. 



September, 1960 



EDITORALS 



385 



North Carolina Medical Journal 



Owned and published by 

The Medical Society of the State of North Carolina, 

under the direction of its Editorial Board. 



EDITORIAL BOARD 
Wingate M. Johnson, M.D., Winston-Salem 

Editor 
Miss Louise MacMillan, Winston-Salem 

Assistant Editor 
Mr. James T. Barnes, Raleigh 

Business Manager 
Ernest W. Furgurson, M.D., Plymouth 
John Borden Graham, M.D., Chapel Hill 
G. Westbrook Murphy, M.D., Asheville 
William M. Nicholson, M.D., Durham 
Robert W. Prichard, M.D., Winston-Salem 
Charles W. Styron, M.D., Raleigh 

Address manuscripts and communications regarding 
editorial matter to the 
NORTH CAROLINA MEDICAL JOURNAL 
300 South Hawthorne Road, Winston-Salem 7, N. C. 
Questions relating to subscription rates, advertis- 
ing, ect., should be addressed to the Business 
Manager, 203 Capital Club Building, Raleigh, N. C. 
All advertisements are accepted subject to the ap- 
proval of a screening committee of the State 
Journal Advertising Bureau, 510 North Dearborn 
Street, Chicago 10, Illinois, and/or by a Committee 
of the Editorial Board of the North Carolina Medi- 
cal Journal in respect to strictly local advertising 
accepted for appearance in the North Carolina 
Medical Journal. 

Annual subscription, $5.00 Single copies, 75<* 

Publication office: Carmichael Printing Co., 1309 

Hawthorne Road, S.W., Winston-Salem 1, N. C. 



September, 1960 

THE NATIONAL ELECTION 

Although some of our members feel that 
only medical subjects should be discussed 
in the editorial columns of this journal, the 
editorial board takes the broader view that 
doctors need to be well rounded citizens, 
and that the inclusion of topics of a gen- 
eral nature makes for a greater appeal. The 
widespread interest in the Democratic and 
Republican Conventions justifies the as- 
sumption that some of our readers would 
not object to a few impressions of the po- 
litical situation from a viewpoint as inde- 
pendent and unbiased as human nature will 
allow. The views expressed are those of the 
editor and do not necessarily reflect the 
opinion of the members or officials of the 
North Carolina Medical Society. 

The nomination of the candidates for the 
presidency was for each party a foregone 
conclusion. Both successful candidates had 
paved the way by long and arduous ground- 
work. As James Reston said in his Neiv 



York Times column for July 31 : "We have 
two efficiency experts as presidential can- 
didates." 

The choices for the vice presidency, how- 
ever, had not been settled in advance of the 
political conventions. The selection of Lyn- 
don Johnson was a distinct surprise and 
somewhat of a shock to many. After the 
caustic comments Kennedy and Johnson 
had exchanged before the convention, John- 
son's selection by Kennedy, and his ready 
acceptance, proved anew that politics does 
indeed make strange bedfellows. 

The selection of Henry Cabot Lodge was 
not so surprising. His yeoman service in 
the United Nations has made him a recog- 
nized authority on our foreign relations. 
Parenthetically, when one recalls that his 
grandfather took the lead in sabotaging 
Woodrow Wilson's League of Nations, the 
active role he has played in the United Na- 
tions illustrates well John Charles Mc- 
Neill's lines: 

How teasing truth a thousand faces claim, 

As in a broken mirror; 

And what a father died for in the flames, 

His own son scorns as error. 

Just as Kennedy subdued his personal 
feelings toward Johnson in order to win his 
support, Nixon yielded to Nelson Rocke- 
feller's demands for a strong civil rights 
plank in the Republican Platform, even at 
the cost of breaking away from Eisen- 
hower's position and of offending the South- 
ern delegates. In exchange, Rockefeller 
agreed to give up — for the time at least — 
his own presidential ambitions and to nom- 
inate Nixon, even though he could not re- 
member the middle initial. 

As the result of Mr. Nixon's need to pro- 
pitiate Mr. Rockefeller, the platforms of the 
two parties do not offer the independent 
voter too much choice — though the Demo- 
crats were decidedly more lavish with 
promises than the Republicans. As Senator 
Ervin was quoted as saying, however, in an 
effort to make the Southern delegates ac- 
cept the civil rights plank, "Platforms are 
made to run on, not to stand on." 

There is still some ground for the opinion 
expressed by Dr. John K. Glen in the Texas 
State Journal of Medicine for July, 1956 — 
that non-voters should not be censured for 
staying away from the polls, because there 
is not enough difference in the policies of 



38ti 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



the two major parties to justify the trouble 
of voting: "Therefore, a host of conscien- 
tious non-voters is abuilding and becoming 
a mighty army. Someone has said, 'What 
we don't need in the United States is a third 
party. What we do need is a second party.' ' 

And a recent article in the Saturday Re- 
view by Professor and Mrs. Robert Rienow 
asserts that many non-voters ai'e so indiffer- 
ent and so ignorant of political affairs that 
they should not be urged to vote. At least 
there is much to be said for a minimum de- 
gree of intelligence as a requirement for 
voting. This requirement should, of course, 
be applied to whites as well as to non- 
whites. 

We may expect the hardest fought cam- 
paign since Herbert Hoover defeated Al 
Smith. Both candidates have expressed will- 
ingness to accept the offer of free time for 
joint debate made by the major broadcast- 
ing systems. If rightly used, these debates 
should stimulate widespread interest in the 
campaign. 

It is to be hoped that the contest will not 
degenerate into a mud-slinging affair, but 
that each candidate may take the high road 
instead of the low one. Both men are high- 
ly intelligent and articulate and we may ex- 
pect each one to present his case forcefully. 
Let us hope that each candidate will think 
in terms of the welfare of the country in- 
stead of the number of the votes he can win 
by the stand — or stands — he takes. Let us 
hope also that citizens will decide how to 
vote after carefully studying the merits of 
each candidate and the vital issues ahead, 
and may the number of independent voters, 
and of the really conscientious non-voters, 
continue to increase. 

* ^ !;: 

SABIN LIVE-VIRUS POLIO 
VACCINE APPROVED 

After waiting until its use in millions of 
people had established its safety, Surgeon 
General Burney has approved the general 
use of the Sabin attenuated live-virus vac- 
cine. Two other live-virus vaccines have 
been developed — one by Lederle's Dr. 
Herald R. Cox, the other by Dr. Hilary Ko- 
prowski of the Wistar Institute in Phila- 
delphia. As yet, the one developed by Dr. 
Albert B. Sabin of Cincinnati is the only 
one approved. 

The acceptance of a live-virus vaccine for 
immunization against polio is good news for 
doctors, parents, and children. There is no 



doubt but that the live virus confers a more 
lasting, perhaps a permanent, immunity 
against polio, and the fact that it is taken 
by mouth in a pleasant tasting vehicle 
makes it far more acceptable to children, 
and also to adults, than the hypodermic 
needle method. 

Although the Sabin vaccine has been ap- 
proved, it will be some time yet before the 
manufacturers have produced enough to 
make it available for general use, and it is 
not yet certain how it will be distributed. 
The United States Public Health Committee 
on Live-Virus Vaccines believes that the 
most effective way to eradicate polio would 
be to give the vaccine in mass vaccination 
programs rather than in the unsaturated 
contact by private practitioners. This 
method was used in Russia and other for- 
eign countries with very favorable results 
reported. The committee also recommended 
that the vaccination program should be 
continued year after year. 

The problem of finding the best way to 
distribute the live-virus vaccine will re- 
quire cooperation between private physi- 
cians and the Public Health worker. It does 
not seem too much to hope that the univer- 
sal use of this type of vaccine may mean 
that before too long paralytic polio may be 
as rare as is typhoid now. 

ABOLISH AGE DISCRIMINATION 
IN EMPLOYMENT? 

Senator Pat McNamara deserves com- 
mendation for introducing, on June 22, a 
bill (S.3726) to abolish age discrimination 
in employment under federal contracts. In 
introducing the bill. Senator McNamara 
said in part: 

We have listened to the direct testimony of 
jobseekers under the age we usually think of as 
"old,'' and have studied reports about discrim- 
ination in employment against men and women 
of 40 — even as young as 30 and 35 in some 
cases . . . 

We have adequate scientific evidence now that 
age by itself — especially for the group I have 
reference to, under 65 — is absolutely no basis 
for deciding whether or not to hire a new worker 
or replace an older employee . . . 

Even in times of full employment — when labor 
is scarce — the practice of age discrimination in 
employm3nt exists . . . 

It is more and more important that we broad- 
cast the facts about the argument that higher 
pension costs are the real obstacle to hiring 
older woi kers. The Department of Labor's stud- 



September, 1960 



EDITORALS 



387 



ies of this type of argument have concluded that 
such costs need not stand in the way of a sound 
policy of hiring- on the basis of a person's actual 
ability to do the job — and not his or her age. 

The bill I am introducing (S.3726)— with the 
co-sponsorship of Senators Clark and Randolph — 
will be a major step toward reducing this shame- 
ful and unnecessary practice. 

It would show that the Government itself is 
practicing what it preaches — by requiring that 
all its contracts with furnishers of goods and 
services adopt personnel policies on the basis 
not of age — but of a person's actual physical 
and mental abilities to perform his work — on the 
basis of his personal merits — and not how long- 
ago he was born. 

This bill also requires that the Secretary of 
Labor organize and conduct labor-management 
conferences for the purpose of implementing- and 
distributing information about the policy of the 
Act. 

S.3726, if passed, should do much to en- 
courage the continued usefulness and self- 
respect of many now forbidden gainful em- 
ployment because they are past the 40-year 
mark. 

North Carolina has been a pioneer in 
crusading for fair age-employment policies. 
In his address to the State Conference on 
Aging, Governor Hodges made a vigorous 
protest against turning people out to pas- 
ture merely because they have reached a 
certain age. And long before that he had 
endorsed a brochure entitled "A New Look 
at the Mature Worker," published by the 
Governor's Coordinating Committee on Ag- 
ing. This brochure anticipated the reason- 
ing of Senator McNamara's bill. 



OCCUPATIONAL HEALTH ISSUE 

Industrial — or occupational — health has 
become a career that is attracting more and 
more physicians. Next month North Caro- 
lina will for the first time be host to the 
A.M. A. Congress on Industrial Health, to 
be held in Charlotte October 1-12. 

In anticipation of this important event 
this issue of the North Carolina Medical 
Journal contains a collection of papers on 
various phases of occupational health. It 
will be noted that the relation of the pri- 
vate practitioner to this special field is 
stressed. These papers constitute a valuable 
source of information on an increasingly 
important subject. 



THE SPEEDING AMBULANCE 

A number of editorials have been written 
in this and other journals on the menace of 
the speeding ambulance. A recent news 
story, however, of an ambulance wrecked 
while conveying to the hospital the victim 
of another wreck gives an occasion for one 
more protest. The only real reason for an 
ambulance to speed through town with the 
siren wide open and flashing red lights is 
the advertising feature. Someone has said 
that it would be just as effective advertis- 
ing and safer for the passenger patients if 
ambulances were equipped with sound de- 
vices to proclaim at frequent intervals, 
"This is X's ambulance!" 

It is pertinent to quote again from an 
article in the Journal of the Michigan State 
Medical Society (September, 1957) by Drs. 
George J. Curry and Sydney N. Lyttle : "An 
ambulance averaging 30 miles per hour 
would require 10 minutes to travel 5 miles. 
To save 5 minutes, 60 miles per hour would 
be necessary. In 2,500 consecutive ambu- 
lance runs, this time-interval would not 
have influenced the course of a single in- 
jury." The authors added, however, that 36 
victims were in severe shock upon arrival 
at the hospital and that "The degree of 
shock may have been increased by a rough 
ride in an ambulance." 

Is it not time for some legal restrictions 
to be put upon the ambulance? 



MAIL ORDER PRESCRIPTIONS 

At the Miami Beach Meeting of the 
A.M. A. a resolution was unanimously 
adopted condemning prescriptions by mail 
order except when no other way was avail- 
able. In this issue Mr. H. C. McAllister, 
Secretary-Treasurer of the North Carolina 
Board of Pharmacy, gives clear-cut and log- 
ical arguments against the prescription 
service by mail now being offered by many 
out of state concerns. Every doctor should 
read this article and learn from it how to 
advise his patients not to risk their health 
by falling for the lure of "price discounts." 
The doctor and the pharmacist should work 
together as a team for the benefit of the 
patient — and this teamwork is not possible 
when the pharmacist is far off in another 
state. 



388 



NORTH CAROLINA MEDICAL JOURNAL 



September, 19fi0 



President's Message 



As conscientious and ethical American 
practitioners of medicine, our primary mo- 
tivation must always be to initiate and sup- 
port those qualities of medical care which 
are productive for the best interests of the 
people of this Nation. However, the instinct 
of self-preservation, being perhaps the 
strongest instinct with which humans are 
endowed, motivates us as physicians, just 
as other organized groups in society are 
motivated, to advocate and support those 
principles which are favorable to the pro- 
fession, provided they be compatible with 
the best interests and well-being of our peo- 
ple. 

Controversy relates very closely to moti- 
vation and quite often, in extremes, pro- 
vides an overflow of bitterness. Currently, 
there is tremendous awareness, controver- 
sy, and some bitterness concerned with the 
phenomenon of medical care within our 
United States. Our citizenry is currently di- 
vided into two over-all groups who have a 
basic divergence of opinion as to what is 
best for the health and well-being of our 
people, specifically with regard to the pro- 
vision of medical care on a national level. 

On the one side are those, motivated by 
socialistic urges and political expediency, 
who advocate medical care as a service of 
the Federal Government. This group, in ef- 
fect, has already altered our Bill of Rights 
to include, in addition to the rights to "Life, 
Liberty, and the Pursuit of Happiness," the 
right to share the national wealth by tax- 
ation ; the right of labor to strike and bar- 
gain collectively; Social Security; support 
and regulation for agriculture and business. 
Now these people would add the right to 
total medical care as a function and service 
of the Federal Government. This last right 
is to be furnished regardless of the indi- 
vidual's ability or desire to provide such 
service for himself. 

All physicians hold the opinion that 
everyone is entitled to medical care. We be- 
lieve, however, that the provision of this 
commodity, in its entirety for all people, is 
not rightfully a function of the Federal 
Government. In accord with physicians in 
this belief is an equally large, better in- 
formed, and better educated, properly moti- 
vated segment of American society. This 
group believes and can document the fact 



that socialized medicine is synonymous with 
inferior medical care and stagnation of 
medical progress through research. It is 
basic that a competitive spirit is yet re- 
garded as essential to the vigor and quality 
of medical research and the excellence of 
medical care, because, as ever, it is the 
principal source of incentive and motiva- 
tion. 

Recently, a large group of business, farm, 
and professional people in this country pre- 
vailed upon a coalition of Northern Repub- 
licans and conservative Southern Democra- 
tic Senators to defeat a bill before the Sen- 
ate designed to initiate the socialization of 
medicine. This bill embodied the principle 
of government relative to medical care as 
set out by the Platform of the National 
Democratic Party. This legislation was en- 
thusiastically supported by the Democratic 
candidates for the Presidency and Vice 
Presidency, Senators Kennedy and Johnson. 
More adamant in support of this legislation 
were the leaders of organized labor and 
labor unions. 

Fortunately, North Carolina has in its 
two Senators men of understanding char- 
acter who possess the ability to analyze and 
understand this type of proposed legisla- 
tion. Senators Ervin and Jordan are also 
men of stability and conviction, who pos- 
sess the fortitude to vote their sincere con- 
victions regardless of party affiliation. Both 
of our Senators strongly advocated the de- 
feat of this bill designed to provide total 
Federal medical care to all recipients of 
Social Security. These men knew this bill 
for what it was and recognized that it 
would reflect to the detriment of our people. 

Senators Jordan and Ervin did support 
and help pass a bill which meets, head on, 
the problem of governmental assistance in 
the provision of medical care for the needy 
and near needy. Realistically, this bill, 
which was supported by medicine, provides 
for financial participation and administra- 
tion at state and local levels. 

Physicians as a group or as individuals 
can no longer afford to hold aloof from the 
social, economic, or political facts of life. 
There is no longer room in medicine for 
cynicism and indifference as applied to the 
basic concepts of medicine as a free enter- 



September, 1960 



PRESIDENT'S MESSAGE 



389 



prise system productive of the best medical 
care known to the world. There are those 
prevalent and active who would make of 
our profession a trade; of our medical 
academies, trade schools ; of the Federal 
Government, our employers, and of our 
standards of excellence, monotonous medi- 
ocrity. Medicine must tighten its ranks and 
protect vigorously those things which we 
hold to be inalienable to high quality med- 
ical care. 

May I urge that all physicians commence 
now to give generously of themselves as 
well as of their possessions to support those 
in government and politics who uphold the 
principles of quality medical care for our 
people. It is essential, but not enough, to 
give your money to support our friends in 
government. Giving one's self, one's time, 
one's effort, and one's personal influence is 
real giving. Medicine has the potential. No 
group in North Carolina has the personal 
contacts, the opportunity, and the ability 
to influence the thinking of our people, to 
the well-being of all concerned, as do North 
Carolina's physicians. It is imperative that 
we take a few minutes each day with each 
contact to exercise this prerogative. 

One Southern Senator, name unidentified, 
who recently supported conservative med- 
ical legislation gave as his reason for such 
action the fact that he had three thousand 
doctors in his state on his side. He further 
stated that he knew of no other group of 
three thousand persons whom he would 
rather have on his side. There is reason to 
believe that this was the statement of a 
North Carolina Senator. Let us not let him 
down. 

Amos N. Johnson, M.D. 



BULLETIN BOARD 



COMING MEETINGS 

State 

Ninth District Medical Society Symposium — 
Moose Lodge, Morganton, September 29. 

North Carolina Fifth District Medical Society 
meeting — Mid Pines Club, Pinehurst, October 5. 

North Carolina Society for Crippled Children 
and Adults, Twenty-fifth Annual Meeting — Wash- 
ington-Duke Hotel, Durham, October 6-8. 

Eleventh Annual Winston-Salem Heart Sympo- 
sium — Robert E. Lee Hotel, Winston-Salem, Octo- 
ber 7. 

North Carolina Board of Medical Examiners, in- 
terviews with candidates for license by endorse- 
ment — Virginia Dare Hotel, Elizabeth City, Octo- 
ber 7. 

Blue Shield Plans, Annual Program Conference 
—Drake Hotel, Chicago, October 10-11. 

A.M.A.'s Twentieth Annual Conference on In- 
dustrial Health— Charlotte, October 10-12 

Seventh District Medical Society, Annual Meet- 
ing — Gaston Country Club, Gastonia, October 19. 

Duke University Postgraduate Medical Seminar 
Cruise to the West Indies — November 9-18. 

Ninth Annual Gaston Memorial Hospital Sym- 
posium — Masonic Temple, Gastonia, November 17. 

North Carolina Academy of General Practice, 
Annual Meeting — Carolina Hotel, Pinehurst, No- 
vember 27-30. 

Regional and National 

A.M.A.'s First Regional Conference on Rural 
Health (Southeastern states) — Dinkier-Plaza Hotel, 
Atlanta, Georgia, October 7-8. 

American College of Surgeons, Forty-sixth An- 
nual Clinical Congress — San Francisco, October 
10-14. 

American Rhinologic Society, Sixth Annual 
Meeting — Belmont Hotel, Chicago, October 8. 



Winston- Salem 



•••i a D Greensboro 

•• • • 

• *Q Raleigh 




••• 



• • 



••• 



MATERNAL DEATHS REPORTED IN NORTH CAROLINA^ 
SINCE JANUARY I, I960 

Each dot represents one death 



Washington,^ v£> 




* r 

Wilmington,./ 




:!!iii 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



American Heart Association, Annual Meeting — 
St. Louis, October 21-22. 

Southeastern Allergy Association, Fifty-fourth 
Annual Meeting — Atlanta Biltmore Hotel, Atlanta, 
October 21-22. 

Southern Chapter, American College of Chest 
Physicians, Seventeenth Annual Meeting — Statler- 
Hilton Hotel, St. Louis, October 30-31. 

Southern Medical Association, Annual Meeting 
— St. Louis, October 31-November 3. 

Sixty-seventh Annual Convention of Military 
Surgeons — Washington, D. C, October 31-Novem- 
ber 2. 

American Medical Writers' Association — Morri- 
son Hotel, Chicago, November 18-19. 

Southeastern Region of the College of American 
Pathologists and the Virginia Society of Patholo- 
gists: Seminar on Kidney Diseases — John Marshall 
Hotel, Richmond, Virg-inia, November 25-26. 

Emory University Postgraduate Course in Oph- 
thalmic Surgery — Grady Memorial Hospital, Atlan- 
ta, December 1-2. 



New Members of the State Society 

The following physicians joined the Medical So- 
ciety of the State of North Carolina during the 
month of August, 1960: 

Dr. Claudia Gertrude Oxner, St. Joseph's Hos- 
pital, Asheville; Dr. Luman Harris Tenney, Route 
1, Arden; Dr. John Thomas Dayton, 3800 N. Inde- 
pendence Blvd., Charlotte 5; Dr. Charles Otis 
Chrysler, 3800 N. Independence Blvd., Charlotte; 
Dr. William Joseph Callison, 108 Doctors Building, 
Asheville; Dr. Robert Earl Nolan, O'Hanlon Build- 
ing, Winston-Salem; Dr. Henning Frederick 
Adickes, Jr., 2832 Selwyn Avenue, Charlotte; Dr. 
Julian Barker, 1012 Kings Drive, Charlotte; Dr. 
Hugh Harrison Hayes, Jr., 3212 Country Club 
Drive, Charlotte; Dr. William Malcolm Eubanks, 
Jr., 4200 Park Road, Charlotte; Dr. Cecil Lawrence 
Johnston, 1616 Palm St., Goldsboro. 



News Notes from the Bowman Gray 
School of Medicine 

Dr. Isadore Meschan, professor of radiology and 
chairman of the Department of Radiology, has 
been awarded a cancer related research training 
grant (radiation biology) by the National Cancer 
Institute of the National Institutes of Health. The 
grant is in the amount of $365,000 for a period of 
three years and nine months. 

The training program will be sponsored through 
the Department of Radiology, and will be under 
the direction of Dr. Donald J. Pizzarello. The pro- 
gram was activated on September 1, 1960, and it 
is anticipated that the first trainees will be ap- 
pointed for a January term. 

In addition to his duties as director of the radi- 
ation biology training program, Dr. Pizzarello will 
also serve as a member of the teaching staff. He 
holds the bachelor of arts, master of science and 



doctor of philosophy degrees from Fordham Uni- 
versity, New York City. For the past year he has 
been a research fellow at the Argonne National 
Laboratory, Division of Biological and Medical Re- 
search, Argonne, Illinois. 

In addition, 14 research grants from the U. S. 
Public Health Service, totaling $266,453 for the 
coming year, were awarded to the Bowman Gray 
School of Medicine during the month of August. 
Among the largest was a $50,000 award to Dr. 
Richard L Burt for "Studies on Carbohydrate 
Metabolism in Pregnancy" and $43,025 to Dr. Nor- 
man M. Sulkin for "Ultrastructure of Nerve Cells 
in Experimental Aging." In the latter grant, funds 
are approved for the purchase of an electron micro- 
scope. Dr. Robert W. Prichard and Dr. Martin G. 
Netsky were awarded $29,440 for "Studies on 
Spontaneous Atherosclerosis," and Dr. Harold D. 
Green received approval of a grant for "Inter-re- 
lation of Venous Return and Vasomotor Tone." 

* # * 

Dr. Eben Alexander, Jr., professor of neurosur- 
gery, has been appointed to the editorial board of 
the Journal of Neurosurgery. The appointment is 
effective January 1, 1961. 

Dr. Walter J. Bo, a native of Minnesota, has 
joined the faculty as associate professor of anato- 
my. Previously, Dr. Bo was associate professor of 
anatomy at the University of North Dakota School 
of Medicine at Grand Forks, North Dakota. 

A graduate of Marquette University, Dr. Bo 
also received a master of science degree in zoology 
from that school. He holds a doctor of philosophy 
degree from the University of Cincinnati School 
of Medicine Graduate School. 

He has been an instructor in zoology at Xavier 
University at Cincinnati, a teaching fellow in his- 
tology at the University of Cincinnati, a cancer re- 
search fellow at the University of Cincinnati, and 
assistant professor of anatomy at the University of 
North Dakota Medical School. 

* * * 

Dr. Alanson Hinman, assistant professor of pe- 
diatric enurology, has returned from a three year 
leave of absence. During his leave, Dr. Hinman 
served as a special clinical trainee in neurology at 
Columbia University, College of Physicians and 
Surgeons, New York City. 

Dr. Richard C. Proctor, associate professor of 
psychiatry, has been named chairman of the De- 
partment of Psychiatry. 

Dr. Angus Randolph, associate professor of psy- 
chiatry, has served as acting chairman of the de- 
partment since 1956. He will continue as a member 
of the full-time faculty. 

Dr. Proctor graduated from Wake Forest Col- 
lege in 1942 and from Bowman Gray School of 
Medicine in 1945. He served an internship and resi- 
dency at the U. S. Naval Hospital, Bremerton, 



September, 1960 



BULLETIN BOARD 



391 



Washington; the N. S. Naval Hospital, Great 
Lakes, Illinois; and at Graylyn. He joined the 
Bowman Gray faculty in July, 1950. 

He has served as secretary-treasurer of the 
Southern Psychiatric Association and president of 
the Day Care Nursing Association. He is a mem- 
ber of the American Psychiatric Association, the 
North Carolina Medical Society, the Forsyth 
County Medical Society, the Southern Medical As- 
sociation, and the Tri-State Medical Society. 

From 1950 to 1952, Dr. Proctor served as assist- 
ant director of Graylyn. In January, 1959, he 
moved his office from Graylyn to the Bowman 
Gray School of Medicine, where he continues as a 
full-time member of the faculty. 

Dr. James B. Wray, instructor in orthopaedics, 
will assume his new duties as chairman of the 
Section on Orthopaedics at the State Medical Uni- 
versity of New York, Upstate Medical Center, Syr- 
acuse, New York, on October 1, 1960. 

Dr. Wray has served as a member of the Bow- 
man Gray faculty since July, 1957. 



News Notes from the Duke University 
Medical Center 

As announced earlier, the Duke University Med- 
ical School is sponsoring a postgraduate Medical 
Seminar Cruise to the West Indies this fall aboard 
the new Kungsholm, Sweden's largest transatlantic 
liner and cruise ship. The luxury ship, which will 
sail from New York City on November 9, will 
visit the Virgin Islands and San Juan, Puerto Rico, 
and will return to New York on November 18. 

Shipboard lectures on various subjects in medi- 
cine, pediatrics and surgery will be given by the 
following members of the Duke Medical School 
faculty: Dr. Edwin P. Alyea, professor of urology; 
Dr. Doris Ahlee Howell, associate professor of 
pediatrics and pediatric hematologist; Dr. William 
M. Nicholson, professor of medicine and assistant 
dean for Postgraduate Medical Education; Dr. El- 
bert L. Persons, professor of medicine; and Dr. 
William M. Shingleton, professor of surgery. 

The instructional program will provide 20 hours 
credit toward postgraduate requirements of the 
American Academy of General Practice. While 
designed primarily for the generalist, the program 
should be of value and interest to the specialist. 
Informal panel discussions, clinicopathologic con- 
ferences, and formal presentations will be given 
by members of the faculty. 

A Duke University medical scientists is ap- 
proaching the study of strokes through observa- 
tion of blood vessels inside the eyeball. 

Dr. Albert Heyman, working under a $2,000 
grant from the Wilson County Heart Association, 
is utilizing new techniques for diagnosing abnor- 
malities in the brain's circulatory system and also 
for gaining more information about strokes. He 



plans to study the retinal blood vessels by photo- 
graphing them with specially adapted "eye ground" 
cameras, by making motion pictures, and by meas- 
uring blood pressure inside these vessels. 

Dr. Heyman is an associate professor of medicine 
at the Duke Medical Center. Working- with him in 
the research project is Dr. Regina Frayser, in- 
structor in medicine. They will be assisted by 
photographers in the medical illustration depart- 
ments of Duke Hospital and the Veterans Admin- 
istration Hospital here. 

A new radiation therapy and research division 
has just been completed at the Duke University 
Medical Center and is now in use. 

Providing extensive facilities for radiation treat- 
ment of cancer, the division is housed in a $375,000 
addition to Duke Hospital that has been under 
construction for the past year. 

A "cobalt 60" therapy unit, one of several in 
North Carolina, provides radiation dosage equiva- 
lent to that of a three million volt x-ray machine 
for treatment of deep-seated cancer. 

A "cesium 137" unit represents the latest devel- 
opment in supervoltage radiation therapy equip- 
ment. Small and compact, this unit produces a 
beam similar in many ways to that of a one mil- 
lion volt x-ray machine requiring a two-story space 
for installation. The cesium unit is onn of a few 
now in use in the United States. 

An appointment and a promotion in the admin- 
istrative staff of Duke Hospital were announced 
recently by Charles H. Frenzel, hospital superin- 
tendent. 

James W. Anderson has joined the staff as bus- 
iness officer, succeeding Leonard E. Small. 

John A. Salmon, Jr., has been promoted from 
assistant collections officer to admitting officer, suc- 
ceeding Mrs. Elizabeth Hendricks. 

A six-year research project aimed at producing 
better nurses has been initiated at Duke Univer- 
sity. The study is being conducted jointly by the 
University's Department of Sociology and Anthro- 
pology and the School of Nursing. 

Dr. John C. McKinney, sociology, department 
chairman and principal investigator for the pro- 
ject, said that "in effect, we are studying the for- 
mation of nursing students' professional goals and 
attitudes during the course of their education." 



News Notes from the University 
of North Carolina School of Medicine 

North Carolina Memorial Hospital of the Uni- 
versity of North Carolina received its one hundred 
thousandth patient recently. 

The number 100,000 was marked by the name of 
Mrs. Katie B. Koch of Bailey, a Nash County com- 
munity. Mrs. Koch, a housewife, was treated in the 
Out-patient Clinic of the hospital. 

From a few hundred patients seen in this clinic 
the year the hospital opened — 1952 — the number 



392 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



during the past 12 months has grown to nearly 
60,000. 

The hospital observed the eighth anniversary of 
its opening on September 2. 

* * * 

Dr. Charles H. Burnett, head of the Department 
of Medicine, has been granted a year's leave of 
absence for research work at the University of 
London. During his absence, the department will 
be headed by Dr. Louis G. Welt, professor of medi- 
cine. 

Dr. Robert R. Cadmus, director, and E. B. Craw- 
ford, Jr., assistant director of North Carolina 
Memorial Hospital, flew to Panama City, Panama, 
recently for consultation with officials of a new 
hospital under construction there. 

Memorial Hospital has had a contract to assist 
the Panamanian hospital since the project first got 
underway about two years ago. The new hospital 
is expected to open in a year. 

Experiments have been conducted with a new 
instrument at the University of North Carolina 
School of Medicine which has successfully meas- 
ured the oxygen in the brain of a living animal 

The project was canned out by three anesthe- 
siologists of the Department of Surgery. Dr. Ken- 
neth Sugioka was the principal investigator. He 
was assisted by Drs. David Davis and Rodney Mc- 
Knight, 

An account of this research was given August 
24 at the Stanford University Medical Center at 
Palo Alto, California, before the annual meeting 
of the American Physiological Society. 

Prior to the development of this instrument, 
exact measurement of oxygen in tissue had not 
been possible. 

Dr. Charles E. Flowers, Jr., associate professor 
of obstetrics and gynecology, went to the Univer- 
sity of California recently to establish a special 
study of "Diabetes in Pregnancy" for the Ameri- 
can Medical Association. 

* * * 

A $2 million request to help launch construction 
of a long range health center addition at North 
Carolina Memorial Hospital was included in the 
university's $15.3 million capital improvements 
budget request presented recently to the state's 
Advisory Budget Commission. 

Also included in the total $3,459,000 budget re- 
quest for the Division of Health Affairs for the 
coming biennium is a $1,434,000 appropriation to 
provide complete air conditioning for Memorial 
Hospital and the School of Dentistry. Another 
$25,000 is earmarked for renovation of certain 
areas in the medical school. 

The health center addition would be the first 
stage in a 10-year physical expansion program 
which might cost upwards of $8 million. 



The University of North Carolina is getting a 
$30,000 gift from the will of Mrs. Elva Bryan Mc- 
Iver of Sanford. 

The Council of State has formally accepted a 47- 
acre tract of land valued at $30,000 which Mrs. 
Mclver willed to be used to establish a loan fund 
for medical students at the university. 

The gift was left in memory of Mrs. Mclver's 

husband, the late Dr. Lynn Mclver. 

* * * 

A new training program for persons engaged in 
the care of the mentally ill is being organized by 
the North Carolina State Hospitals Board of Con- 
trol. 

Dr. Charles R. Vernon of the Department of 
Psychiatry, U.N.C. School of Medicine, has been 
named director. 

Dr. Kendall Owen Smith, who has made signifi- 
cant contributions to the knowledge of how vir- 
uses invade living tissue cells in research utilizing 
an electron microscope at the U.N.C. School of 
Medicine, has accepted a position at Baylor Uni- 
versity in Houston, Texas. 

Dr. Smith, a Ph.D. graduate in bacteriology in 
the U.N.C. medical school and a native of Wilson, 
has been since August, 1959, a postdoctorate train- 
ee of the U. S. Public Health Service, working 
with Dr. Gordon Sharp in the newly established 
biophysics laboratory in the School of Medicine 
here. Dr. Smith has worked with Dr. Sharp in ex- 
periments using the electron microscope. 

At Baylor University, Dr. Smith will work with 
Dr. Joseph Melnik, and continuation of experi- 
ments begun at Chapel Hill will be possible. 

:Jc >»-. :;: 

Dr. Richard Dobson, head of the Division of Der- 
matology, spoke recently before the first Interna- 
tional Congress of Histochemistry in Paris, France, 
on the subject of "The Histochemistry of the Hu- 
man Sweat Gland." 

Dr. Dobson is engaged in various studies of the 
skin and the sweat glands. 



Eleventh Annual Winston-Salem 
Heart Symposium 

The eleventh annual Winston-Salem Heart Sym- 
posium will be held at the Robert E. Lee Hotel in 
Winston-Salem on October 7. The program follows. 
Morning 
9:30-10:25 Presiding: Robert L. McMillan, M.D. 
Governor, North Carolina American 
College of Physicians, Winston-Salem 
"Recent Advances In Experimental 
Atherosclerosis" 

Thomas H. Clarkson, D. V. M., Win- 
ston-Salem 
10:25-11:15 "Human Atherosclerosis and Lipid 
Metabolism: Current Concepts" 
Donald Fredrickson, M.D., Bethesda, 
Maryland 






September, 1960 



BULLETIN BOARD 



393 



11:30 A.M.-1:00 P.M. Panel 

"Clinical Management of Athero- 
sclerosis" 

Diet, Cholestorol-lowering Drugs, 
Anti-coagulant, Surgery 
Moderator: Robert W. Priehard, M.D., Winston- 
Salem 
Participants: Edward S. Orgain, M.D., Durham 
Henry T. Bahnson, M.D., Baltimore, 
Maryland 

Donald Fredrickson, M.D., Bethesda, 
Maryland 
1:00 P.M. Lunch 

Afternoon 

2:00- 2:50 Presiding: Charles R. Welfare, M.D., 
Winston-Salem, President, Forsyth 
County Medical Society 
"Treatment of Hypertensive Vascular 
Disease" 
Edward S. Orgain, M.D., Durham 

2:50- 3:40 "Surgical Management of Vascular 
Occlusive Disease" With Special 
Comments on Treatment of Carotid 
Obstructive Syndromes. 
Henry T. Bahnson, M.D. 

3:50- 4:40 "External Cardiac Resuscitation" 

A New Technique of Cardiac Massage 
Without Opening the Chest. 
James R. Jude, M.D., Baltimore, 
Maryland 

4;: 40- 5:40 P.M. Clinico-Pathological Conference 
Edward S. Orgain, M.D. 

6:00- 7:00 Social Hour 

7:00 Dinner 

Presiding: Mr. James A. Way, 
President, Forsyth County Heart 
Association, Winston-Salem 
Speaker: Dr. Mark Depp, Pastor, 
Centenary Methodist Church, 
Winston-Salem 

Introductions: Benjamin F. Huntley, 
M.D., Chairman, Heart Symposium, 
Winston-Salem 



Seminar on Athletic Injuries 

The University of North Carolina School of 
Medicine, in cooperation with the North Carolina 
High School Athletic Association and the North 
Carolina Committee on Trauma of the American 
College of Surgeons, co-sponsored a one-day sem- 
inar on "The Prevention and Management of 
Athletic Injuries" at North Carolina Memorial 
Hospital on September 21. 

Guest member of the seminar faculty was Dr. 
Charles J. Frankel of the Department of Ortho- 
pedic Surgery and athletic team physician of the 
University of Viriginia. Dr. William P. Richard- 
son, assistant dean for continuation education pre- 
sided. - ■■■'_■ 



North Carolina Heart Association 

Dr. Eugene A. Stead, Jr., professor and chair- 
man of Medicine at Duke, will deliver the Lewis A. 
Conner Memorial Lecture at the opening Scientific 
Session of the American Heart Association's an- 
nual meeting in St. Louis on October 21. His topic- 
is "Physiology of the Circulation as Viewed by the 
Internist." The remainder of this session will be 
conducted jointly by the American Heart Council 
on Clinical Cardiology and the American College 
of Cardiology. 

Forms for registering for attendance may now 
be obtained from the North Carolina Heart Asso- 
ciation, Miller Hall, Chapel Hill, North Carolina. 



North Carolina Board of 
Medical Examiners 

The North Carolina State Board of Medical Ex- 
aminers will meet at the Virginia Dare Hotel, Eliz- 
abeth City, on October 7, to interview applicants 
for license by endorsement. 



Ninth District Medical Society 
Symposium 

The annual Ninth District Medical Society Sym- 
posium will be held at Moose Lodge in Morganton 
on September 29. 

Officers of the Ninth District Society are: pres- 
ident — Dr. G. M. Billings; vice president, Dr. J. B. 
Helms; secretary-treasurer, Dr. L. B. Snow. 

For further information, write, Dr. L. B. Snow, 
Drawer 150, Morganton, North Carolina. 



Edgecombe-Nash Medical Society 

The Edgecombe-Nash Medical Society held its 
monthly meeting in Rocky Mount on August 10. 
Dr. Raymond Adams of the Department of Neur- 
ology, Medical College of Virginia, was guest 
speaker. 



News Notes 

Drs. Hall, Lafferty, Coppedge, Burnett, and 

Roth of Charlotte have announced the association 

of Dr. Hugh Harrison Hayes, Diplomat of the 

American Board of Radiology, in the practice of 

radiology. 

* * * 

Drs. Paul W. Sanger and Frederick H. Taylor 
of Charlotte announce the association of Dr. Fran- 
cis Robicsek in the practice of cardiovascular and 
thoracic surgery. 



Southeastern Rural Health Conference 

Physicians and farm group representatives from 
11 Southeastern states will gather in Atlanta, 
October 7-8, for the first regional conference on 
rural health. 

"Joining Hands for Community Health" is the 
theme of the meeting, which will be held at the 
Dinkier Plaza Hotel and is sponsored by the 



394 NORTH CAROLINA MEDICAL JOURNAL September, 1960 



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September, I960 



BULLETIN BOARD 



395 



American Medical Association's Council on Rural 
Health. 

High light of the conference will be a banquet 
address Friday evening, October 7, by Dr. Julian P. 
Price, Florence, South Carolina, newly appointed 
chairman of A.M.A.'s Board of Trustees. 

Conference co-chairmen are Drs. Francis T. Hol- 
land, Tallahassee, Florida, and W. Wyan Wash- 
burn, Boiling Springs, North Carolina. 



SOUTHEASTERN SURGICAL CONGRESS 
The Southeastern Surgical Congress announces 
a prize award contest open to residents of ap- 
proved hospitals in the Southeastern states for the 
best scientific papers submitted 

Papers are due at the Congress office at 340 
Boulevard, N.E., Atlanta 12, Georgia, before De- 
cember 1, 1960. 

First prize is an all-expense-paid trip to the 
meeting at Miami Beach, Florida, March 6-9, 1961, 
in addition to a cash award. 



Emory University School of Medicine 

The Department of Ophthalmology, Emory Uni- 
versity School of Medicine, will sponsor a post- 
graduate course in ophthalmic surgery to be held 
on December 1 and 2, 1960, in the auditorium of 
the Grady Memorial Hospital, Atlanta, Georgia. 

Diagnostic principles and techniques, preopera- 
tive and postoperative management, and surgical 
principles and techniques in extraocular muscle 
surgery, cataract surgery and glaucoma surgery 
will be discussed. 



American College of Gastroenterology 

The twenty-fifth annual convention of the 
American College of Gastroenterology will be held 
at the Bellevue-Stratford Hotel in Philadelphia, 
Pennsylvania on October 24, 25, and 26. 

For copies of the program and additional infor- 
mation, please write to the American College of 
Gastroenterology, 33 West 60th Street, New York 
23, New York. 



American Board of 
Obstetrics and Gynecology 

The next scheduled examination (Part 1), writ- 
ten, will be held in various cities of the United 
States, Canada, and military centers outside the 
Continental United States, on Friday, January 13, 
1961. 

Reopened candidates are required to submit case 
reports for review 30 days after notification of 
eligibility. Scheduled Part 1 and candidates resub- 
mitting case reports are required to submit case 
reports prior to August 1 each year. 

Current Bulletins may be obtained by writing 
to Dr. Robert L. Faulkner, executive secretary and 
treasurer, 2105 Adelbert Road, Cleveland 6, Ohio. 



American College of Chest Physicians 

The Southern Chapter of the American College 
of Chest Physicians will hold its seventeenth an- 
nual meeting at the Statler-Hilton Hotel, St. Louis, 
Missouri, Ocober 30-31, 1960. All physicians are 
cordially invited to attend. There is no registration 
fee. 



National Conference on the 
Medical Aspects of Sports 

The Second National Conference on the Medical 
Aspects of Sports sponsored by the American Med- 
ical Association will be held in Washington, D. C, 
at the Statler Hotel on November 27. The confer- 
ence will immediately precede the annual Clinical 
Meeting of the American Medical Association, No- 
vember 28-December 1, 1960. 

As was true of the first meeting on this subject, 
held last year in Dallas,, the Second Conference 
will cover a wide range of subjects. Included will 
be papers, panels, and discussions relating to 
training and conditioning, prevention of injuries, 
recognition, referral and treatment of injuries, the 
psychology of sports participation and other sub- 
jects. 

Those interested in receiving announcements 
concerning the conference should address The 
Secretary, Committee on the Medical Aspects of 
Sports, American Medical Association, 535 North 
Dearborn, Chicago 10, Illinois. 



Guild of Prescription Opticians 
of America, Inc. 

Dr. William R. Harris of Henderson, North Car- 
olina is among six new residents in ophthalmology 
who have been announced as the 1960 winners of 
fellowships provided by the Ophthalmology Schol- 
arship Fund of the Guild of Prescription Opticians 
of America, Inc. Dr. Harris will serve his resi- 
dency at the Ohio State University Hospital, Co^ 
lumbus, Ohio. 



American Medical Writers Association 

Because of a conflict with observance of Yom 
Kippur on October 1, the American Medical 
Writers' Association has changed the dates of its 
seventeenth annual meeting to November 18 and 
19, 1960, Dr. Austin Smith, president of the so- 
ciety, has announced. The meeting will be held at 
the Morrison Hotel in Chicago. 



The National Foundation 

Postdoctoral fellowships are offered by the Na- 
tional Foundation to candidates for training in re- 
search, orthopedics, preventive medicine, arthritis 
and related diseases, and rehabilitation. The clos- 
ing date for submitting applications to be reviewed 
in February is November 1. 



:;;»; 



NORTH CAROLINA MEDICAL JOURNAL 



September, 19(50 



Catholic Hospital Association 

The new Catholic Hospital Association publica- 
tion on the care of the aged, "The Administration 
of Long-Term Care Facilities," is now available. 

Sixteen recognized authorities in the field of 
geriatric care present material relating to the 
various aspects of care for the aged in an institu- 
tional setting. The papers also deal with problems 
of administration in such facilities. 

Price of the new publication is $1.50 each. Quan- 
tity prices are available on request from the Pub- 
lications Department, Catholic Hospital Associa- 
tion, 1438 South Grand Boulevard, St. Louis 4, 
Missouri. 



Society of Nuclear Medicine 

The Society of Nuclear Medicine recently con- 
cluded its seventh annual meeting in Estes Park, 
Colorado. The following officers were elected: 

President: Titus C. Evans, Ph.D., Iowa City, Iowa 
President-elect: Lindon Seed, M.D., Chicago, 

Illinois 
Vice President: Paul Meadows, M.D., Pittsburgh, 

Pennsylvania 
Vice President-Elect: J. R Maxfield, Jr., M.D., 

Dallas, Texas 
Secretary: Robert W. Lackey, M.D., Denver, 

Colorado 
Treasurer: William H. Beierwaltes, M.D., Ann 

Arbor, Michigan 



The eighth Annual Meeting of the Society of 
Nuclear Medicine will be held at the Penn Shera- 
ton Hotel. Pittsburgh, Pennsylvania, June 14-17, 
liliil 

For further information, address all inquiries to 
the Administrator, Society of Nuclear Medicine, 
430 N Michigan Avenue, Chicago 11, Illinois. 



Animal Care Panel 

Unusual new techniques for handling animals 
used in scientific research will high-light the 
eleventh annual meeting of the Animal Care Panel 
to be held in St. Louis, October 26-28. The success 
with hypnotism of small animal subjects will be 
one of the newer innovations to be reviewed. 

Currently there are slightly more than 800 mem- 
bers in the Animal Care Panel. They include med- 
ical scientists, veterinarians, and caretakers, 
breeders and dealers of animals. 



United States Civil Service Commission 

At least 1,450,000 employees have enrolled in the 
federal employees health benefits program accord- 
ing to preliminary and incomplete registration 
figures received from 35 of the 38 carriers of par- 
ticipating health benefit plans, the Civil Service 
Commission announced recently. The new program 
went into effect early in July. 



adult 
stable 
diabetics 



sulfonylurea 
failures 

respond to 




trademark, 
brand of Phenformin HCI 



adult stable diabetes 

"In our experience the action of DBI on the adult stable 
type of diabetes is impressive . . . 88% were well controlled 
by DBI."i 

"Most mild diabetic patients were well controlled on a 
biguanide compound [DBI], and such control was occa- 
sionally superior to that of insulin. This was true regardless 
of age, duration of diabetes, or response to tolbutamide." 2 

"DBI has been able to replace insulin or other hypogly- 
cemic agents with desirable regulation of the diabetes when 
it is used in conjunction with diet in the management of 
adult and otherwise stable diabetes." 3 



sulfonylurea failures 



Among those diabetics who responded to tolbutamide ini- 
tially and became secondary failures DBI "gave a satis- 
factory response in 55%. " 4 

"DBI is capable of restoring control in a considerable por- 
tion of patients in whom sulfonylurea compounds have 
failed, either primarily or secondarily." 5 

"All twelve secondary tolbutamide failures have done well 
on DBI. "6 

"34 out of 59 sulfonylurea primary failures were success- 
fully treated with DBI." 7 




September, 1960 



BULLETIN BOARD 



397 



U. S. Department of 
Health, Education, and Welfare 

The cooperation of physicians is requested in 
studies on colon and rectal carcinoma recently in- 
itiated at the Clinical Center, National Institutes 
of Health, Bethesda, Maryland. Encouraging re- 
sults in the treatment of gastrointestinal carcin- 
oma have been reported using the pyrimidine an- 
alogues 5-fluorouracil and 5-fluorodeoxyuridine. 
However, other reports have raised the question 
of their effectiveness. 

The Chemotherapy Service of the National Can- 
cer Institute is conducting studies of these agents 
in carcinoma of the colon and rectum in order to 
better define their place in the treatment of meta- 
static gastrointestinal neoplasm. 

Patients can be accepted for these studies if they 
are ambulatory, have normal leukocyte count, 
renal and hepatic function and if they have meta- 
stases in the lung, peripheral lymph nodes (such 
as supraclavicular or cervical) or skin. 

Referrals of such patients will be greatly ap- 
preciated. Physicians who wish to have their pa- 
tients considered for study at the National Cancer 
Institute may write or call: Dr. Clyde 0. Brindley, 
or Dr. Paul P. Carbone, National Cancer Institute, 
Bethesda 14, Maryland. 

A National Center for Health Statistics has 



been established in the Public Health Service, the 
Surgeon General, Dr. Leroy E. Burney, has an- 
nounced. 

The new organizational unit brings together the 
major PHS activities concerned with measurement 
of the health status of the nation and identification 
of significant associations between characteristics 
of the population and health-related problems. 

Initially it will have two divisions: the U. S. 
National Health Survey, which was transferred to 
it on August 15; and the National Office of Vital 
Statistics, which will become part of it on October 
1. It will supplement but not supplant the statis- 
tical work associated with particular Public Health 
Service programs, and which will continue as in- 
tegral parts of those programs. 
* * * 

Sister Hilary Ross, a biochemist, internationally 
known for her laboratory research on leprosy, was 
honored last month by Surgeon General Leroy E. 
Burney of the Public Health Service on the occa- 
sion of her retirement after 37 years of duty at the 
national leprosarium, officially the U. S. Public 
Health Service Hospital, Carville, Louisiana. 

Dr. Burney will present to Sister Hilary a cer- 
tificate citing her for outstanding contribution to 
the care and welfare of patients with leprosy and 
for dedicated effort in developing and communicat- 
ing- new knowledge on this disease. 




blood sugar 
in mild, 
moderate 
and severe 
diabetes, 

in 
children 
and 
adults 



not a sulfonylurea... DBI 

(N^P-phenethylbiguanide) is 
available as white, scored tablets of 
25 mg. each, bottles of 100. 

Send for brochure with complete dosage 
instructions for each class of diabetes, 
and other pertinent information. 



1. Walker, R. S.: Brit. M. J. 2:405, 1959. 

2. Odell, W. D., etal.: A.M.A. Arch. Int. Med. 
102:520, 1958. 

3. Pearlman, W.: Phenformin Symposium, 
Houston, Feb. 1959. 

4. DeLawter, D. E., et al.: J.A.M.A. 171:1786 
(Nov. 28) 1959. 

5. McKendry, J. B., et al.: Canad. M. A. J. 
80:773. 1959. 

6. Miller, E. C: Phenformin Symposium, 
Houston. Feb. 1959. 

7. Krall, L. P.: Applied Therapeutics 2:137, 1960. 

an original development from the research 
laboratories of 

u. s. vitamin & pharmaceutical corp. 

Arlington-Funk Laboratories, division 
250 East 43rd Street, New York 17. N. Y. 



::;i8 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



Veterans Administration 

A search for some of the basic defects that oc- 
cur in the brain in Parkinson's disease, a condition 
afflicting an estimated 500,000 older persons in the 
United States, is under way at the Durham, North 
Carolina, Veterans Administration hospital. 

A medical team under leadership of Dr. Blaine 
S. Nashold, Jr., a neurosurgeon, is investigating 
the effects of drugs in a selected group of patients, 
in the hope that findings will lead to development 
of new and improved treatment methods for the 
disease. 

Appointment of Dr. Robert C. Parkin of Madi- 
son, Wisconsin, as chief of professional training 
services in medical education for the Veterans Ad- 
ministration, in Washington, D. C, was announced 
by the agency recently. 

In his new post, Dr. Parkin will help coordinate 
VA medical education programs which assist in 
training one out of each three new physicians and 
one out of each 10 professional nurses being pro- 
duced by the nation. 



Entitled "The Cancer Detection Examination," 
the forty-six-minute, sound film demonstrates pre- 
symptomatic detection of cancer through a simple 
thirty to forty-minute procedure in the doctor's 
office. 

The material is being offered by Lilly as a free 
service to physicians. 

Lilly salesmen may be contacted by groups of 
physicians for complete information. 



New Film Shows Detection Techniques for Cancer 
A 16-mm., black-and-white movie showing de- 
tection techniques for cancer, which kills more than 
250,000 persons in the United States every year, is 
being offered by Eli Lilly and Company for view- 
ing by qualified professional groups. 



The president of a small drug making company 
declared recently that "the balance on the pharm- 
aceutical industry's ledgers looms more largely 
in the public eye than the physiologic wonders our 
products work and for which mankind has waited 
since time began." 

Speaking to the annual meeting of the Pharm- 
aceutical Manufacturers Association, William C. 
Conner of Alcon Laboratories, Ft. Worth, Texas, 
told the prescription drug makers they "no longer 
toil in blissful anonymity." 

He said, "whatever further action — on the legis- 
lative scene or elsewhere — comes out of the in- 
vestigation, the smaller segments of this com- 
petitive, free-enterprise industry stand to suffer 
at least as much as the larger segments." 

Conner pointed out that nearly a third of the 
companies in the PMA membership do an annual 
business of less than $1 million. 





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September, 1960 



ADVERTISEMENTS 



XXXV 





FLUENCE 



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Concerning Your Health and Your Income 

A special report to members of the Medical Society of 

the State of North Carolina 

on the progress of the Society's 

Special Group Accident and Health Plan 

in effect since 1940 

PROUDLY WE REPORT 1959 

AS OUR MOST SUCCESSFUL YEAR IN SERVING YOUR SOCIETY. 

During the year we introduced a NEW and challenging form of disability protec- 
tion. There has been overwhelming response on the part of the membership. 

Participation in this Group Plan continues to grow at a fantastic rate. 

1960 

is our 20th year of service to the Society. It is our aim to continue to lead the field in pro- 
viding Society members with disability protection and claim services as modern as tomor- 
row. 

SPECIAL FEATURES ARE: 



1. Up to a possible 7 years for each sickness (no confinement required). 

2. Pays up to Lifetime for accident. 

3. New Maximum limit of $650.00 per month income wTiile disabled. 

All new applicants, and those now insured, who are under age 55, and in good 
health, are eligible to apply for the new and extensive protection against sickness and ac- 
cident. 

OPTIONAL HOSPITAL COVERAGE: Members under age 60 in good health may apply for 

$20.00 daily hospital benefit — Premium $20.00 semi-annually. 

Write, or call us collect (Durham 2-5497) for assistance or information. 

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5,000 12,500 to 25,000 

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'Amount payable depends upon the nature of the loss as set forth in the policy. 

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September, 1960 



BOOK REVIEWS 



399 



New Anti-inflammatory Agent Introduced 

An oral systemic anti-inflammatory enzyme 
tablet formulated especially for intestinal ab- 
sorption has been introduced by Armour Pharma- 
ceutical Company. 

Named Chymoral, the product is indicated in all 
conditions where inflammation and swelling are 
present. Chymoral speeds reduction of hematoma 
and edema in injuries, reduces pain and speeds 
wound healing. It may be used in conjunction with 
other medications. 

Clinical investigators reported "good" to "ex- 
cellent" results in 389 cases out of 478, or 82.5 
per cent, when Chymoral was used. Cases included 
asthma, bronchitis, sinusitis, fractures, contusions, 
bruises, thrombophlebitis, pelvic inflammation, a 
number of skin conditions, and such miscellaneous 
conditions as hemorrhoids, cellulitis and conjunc- 
tivitis. 

Chymoral is an enteric coated tablet containing 
both trypsin and chymotrypsin. The product is the 
newest form of chymotrypsin which is already 
available in parenteral and buccal form and as an 
ointment. 

A prescription product, Chymoral is supplied in 
bottles of 48 tablets. The initial dosage is two 
tablets four times a day, and one tablet four times 
a day for maintenance. The tablets may be used 
alone or as a supplement to parenteral Chymar, 
depending on the severity and duration of the in- 
flammatory condition. 



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BOOK REVIEWS 

Manual for Examination of Patients. By 

Kenneth L. White, M.D., and others. 231 
pages. Price, $4.50. Chicago: The Year 
Book Publishers, 1960. 
This manual, put together at the University of 
North Carolina School of Medicine for the benefit 
of students, proved so satisfactory that it has now 
been offered as a handy, paper-backed reference for 
students elsewhere. As such, it fills a need which 
has existed for some years. Books on physical diag- 
nosis in general are vei'bose, redundant, and poor- 
ly correlated with pathology, physiology, and lab- 
oratory diagnosis. Insufficient attention is usually 
given to the finer points of history-taking, which 
have been developed so well by psychiatrists. It is 
therefore a delight to see Dr. White and his col- 
leagues offer a volume with so rational an ap- 
proach. The only comparable volume, "Essentials 
of Diagnostic Examination" by Dr. John B. You- 
mans, was published in 1940 and has been long out 
of print. 

Some of the manual could have been 
re-written, particularly certain sections on labora- 
tory procedure. Not all hospitals and medical 
schools follow the same laboratory procedures as 
does the University of North Carolina Medical 
Center. For example, measurement of butanol ex- 
tractable iodine (BEI) and quantitative urine cul- 
ture are unfortunately not available at all med- 
ical schools. Perhaps the publishers rather than 
the committee are responsible for this defect, be- 
cause a little critical reading could have made it 
apparent. It is a small criticism, however, in light 
of the generally comprehensive approach offered. 
The book is heartily recommended for medical 
students, particularly for those taking physical 
diagnosis, and for junior students first seeing pa- 
tients on the ward. 



Medicine Today. By Marguerite Clark. 360 
pages. Price, $4.95. New York: Funk & 
Wagnalls Company, 1960. 
This book is an excellent summary of the pro- 
gress made by medicine during the past decade. It 
is well written, and for the most part gives a re- 
liable account of recent medical discoveries. Can- 
cer, mental disease, arthritis and rheumatism, 
virus diseases, pediatrics, "women and their ills," 
and reducing diets are discussed. A chapter is de- 
voted to the achievements of the pharmaceutical 
industry. The final chapter, which should keep the 
medical reader humble, is on "Diseases Uncon- 
quered." 

Its easy, chatty style makes the book easy to 
read, and it should not frighten the non-medical 
reader, unless he — or she — is the kind that takes 
all medical descriptions too seriously. The best 
chapters are on psychosomatic disorders and on 
reducing diets. 



11)1) 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



A few minor criticisms will occur to the medical 
reader. The discussion of gout is rather sketchy, 
and the old standby, colchicine is not even men- 
tioned. The undesirable side effects of the steroids 
might have been stressed more. Designating vac- 
cine as ".erom" is a common practice of laymen 
which is particularly irritating to medical men. 

It is unfortunately true, as Mrs. Clark points 
out, that many unnecessary operations are per- 
formed. Her chc!c3 of a case report, however, was 
not convincing evidence. A 25 year old woman 
operated on for acute appendicitis was found to 
have a normal appendix, but a ruptured tubal 
pregnancy. Since the differential diagnosis be- 
tween the two conditions may be quite difficult, 
and since a ruptured tubal pregnancy is certainly 
as grave an emergency as acute appendicitis, no 
surgeon should need to apologize for having oper- 
ated. 

In spite of these minor criticisms, a doctor can 
recommend the book to patients who want to keep 
up to date on medical progress, and most doctors 
can themselves learn much from it. 



Moses Ben Maimon (Maimonides). The 
Preservation of Youth, translated by 
Hirsch L. Gordon, M.D., Ph.D., D.H.L., 92 
pages. Price, $2.75, Philosophical Library, 
New York, 1960. 

Moses ibn Maimon was a great physician of the 
12th century. A Jew of Cordova, and better known 
as Maimonides, he wrote voluminously. He served 
as the personal physician to Saladin of the Cru- 
sades fame and also to Saladin's son, Sultan Al 
Afzal. Upon the request of the latter he wrote a 
collection of essays concerning health, Fi Tadbir 
as-Sihha, and dedicated to Al Afzal. 

Dr. Gordon ably translated and edited these es- 
says under the title, "The Preservation of Youth." 
Very few works of Eastern medical writers of the 
golden age of Islam are translated fully into Eng- 
lish, and this book is a welcome entry. 

Maimondes, though born in Spain, was certainly 
one of the great physicians of the Arab world. He 
also was a noted Jewish theologian. "From Moses 
to Moses there was no greater," says a Jewish 
proverb, meaning from Moses the Prophet to 
Moses the Maimonides. Nevertheless, the pub- 
lishers of this book claim that this is "one of the 

unique medical works of Western culture" 

"translated from the original Arabic"! To this re- 
viewer's knowledge very few, if any, great works 
of Western culture were written by Eastern 
authors, and in Arabic. 

Maimonides borrowed heavily from great phy- 
sicians of Islam. This in itself is advantageous to 
the reader of this book since he can get some in- 
sight into the general trend of medical science of 
the Moslems as it was at the end of the most ad- 
vanced period. The translator has well captured the 
literary style of Maimonides and brought into lime- 



light important points. Throughout the book are 
such remarks as: "Nothing is absolute in medi- 
cine: ... Be optimistic, everything is a matter of 
probability . . . Urban air is polluted, so live in 
the country or suburbs . . . Science is complicated, 
the more we leam the less we know . . . Take a 
short bath every day . . Use music as a therapeutic 
adjunct . . ." These remarks seem to be coming 
out of today's textbooks; however, they were 
written over eight centuries ago! 

It is encouraging to students of the history of 
medicine, and particularly to students of Islamic 
medicine, to see the translation of a complete 
work in this field. Dr. Gordon's translation of 
Maimonides certainly deserves to be in any phy- 
sician's library. 

Foundation Makes New Health Film 
A 22 minute film on preventive medicine has 
been announced by the Smart Family Foundation, 
for showings to PTA groups, pediatricians, public- 
health meetings, and in schools. 

Entitled "Journey in Health," this 16 mm. sound 
motion picture stresses the importance of having 
the family doctor regularly and continually super- 
vice a child's health. 

Since "Journey in Health" was prepared as a 
public service by the Smart Family Foundation, it 
is available at below-cost price. Prints may be ob- 
tained in color for $50; in black-and-white for $10, 
from the Smart Family Foundation, 65 E. So. 
Water St., Chicago 1. 



X-RAY Equipment for sale or exchange. 100 K.V. 
100 M.A. Picker Radiographic unit with manual 
operated tilt table combined with Fluoroscope 
unit beneath the table. Provides instant change 
over from Fluoroscopy to Radiography with spot 
film device. Has had some use but is in excellent 
working order also dark room equipment, mag- 
netic type plate changer. Stereoscopic view boxes, 
etc., will consider late model Ultra-violet lamp, 
surgical endotherm in exchange. Write Box 790, 
Raleigh, North Carolina. 

AVAILABLE Desirable twelve hundred and fifty 
square feet space suitable for doctors or dentist. 
Ground floor Cameron Court apartments, corner 
Snow and Morgan Streets, Raleigh. Air con- 
ditioned, also heat, lights, water and parking. 
On long lease will improve to suit tenant. Apply 
A. W. Criddle, Manager, Temple 2-5395. 

WANTED Otolaryngologist and or Ophthalmolo- 
gist for extremely successful Asheville and 
Western Carolina practice. Dr. Joseph McGowan 
recently deceased. Fully equipped office, exper- 
ienced personnel. Contact Mrs. Joseph McGowan, 
303 Vanderbilt Road, Asheville, North Carolina. 

PRACTICE opportunity. For sale. Complete equip- 
ment of successful physician for practice Internal 
Medicine and offices. Professional Bldg. Raleigh 
available. Write box 1951, Raleigh. 



September, 1960 



IN MEMORIAM 



401 



Kit JtUmorram! 



Earl W. Brian, M.D. 
April 9, 1907— August 1, 1960 

Dr. Eai-1 W. Brian, Raleigh physician and a 
member of the State Board of Health, died at Duke 
Hospital, Monday, August 1, 1960, at 2:00 a.m. 
after an illness of several weeks. 

He had been admitted to the hospital on July 13, 
1960, and had been critically ill since that time. 
Funeral services were held at the Edenton Street 
Methodist Church in Raleigh, conducted by Dr. 
Howard P. Powell, his pastor, and the Rev. R. H. 
Baum, pastor of Ebenezer Methodist Church. 

A native of Arkansas, Dr. Brian received his 
medical degree at Duke University in 1934. He had 
practiced medicine in Raleigh since 1939 and was 
active in professional and civic life and in the 
Edenton Street Methodist Church of which he was 
a member. He was a certified member of the 
American Board of Internal Medicine and had been 
a member of the Wake County and the Medical 
Society of the State of North Carolina since 1939. 

In 1958, Dr. Brian was elected to membership 
on the State Board of Health by the Medical So- 
ciety of North Carolina, and served on this Board 
until his death. 

Dr. Brian was president of the Wake County 
Medical Society for the year 1956-57, president of 
the Raleigh Kiwanis Club in 1953, and president 
of the Executives Club in 1958. He was selected as 
Raleigh's "Kiwanian of the Year" in 1957 and 
was vice president of the United Fund of Raleigh 
in 1956-1957. At the time of his death, he was a 
member of the Board of Directors of the Salvation 
Army and of the Occoneechee Boy Scout Council. 

Dr. Brian was instrumental in the organization 
of the Wake County Cancer Society, was active in 
the Heart Association, and for 17 years was a 
member of the board of the Wake County Tuber- 
culosis Association. 

He is survived by his wife, the former Blanche 
Barringer; two daughters, Mrs. Roy Sehmichel of 
Southburg, Connecticut, and Betsy Brian of the 
home; a son, Earl Brian, Jr., a pre-medical stu- 
dent, who is spending the summer in Germany; 
and four brothers and four sisters. 



James Graham Ramsay, M.D. 

On May 7, 1960, the Supreme Architect of the 
Universe summoned Dr. James Graham Ramsay to 
his celestial home above, there to receive the re- 
ward of a well spent life. 

Dr. Ramsay was a member of the medical and 
surgical staff of Tayloe Hospital prior to its clos- 
ing and the opening of Beaufort County Hospital 
in May, 1958, when he joined the staff of the latter, 
remaining a member until the time of his death. 
He endeared himself to his associates and all with 
whom he came in contact. 



A dedicated and devoted physician and surgeon 
has gone, for the moment, from our midst, but we 
honor his memory today as one who gave his life 
in service to the profession, and left for us high 
and lofty ideals, attained only by those who are 
so dedicated and because of whom the world is 
blessed. 

In his death we are deprived of his genial pre- 
sence and wise counsel, and this community has 
lost an able physician and surgeon, as well as a 
good citizen and friend. 

Now therefore be it resolved that to his family 
and loved ones we express our deep and abiding 
sympathy in their great loss. 

John C. Tayloe 
E. W. Larkin 
James B. Larkin 
Beaufort County Hospital 



The Month in Washington 

Democrats and Republicans are cam- 
paigning on opposing planks on the issue of 
health care for the aged. The Democratic 
party advocates the Social Security ap- 
proach; the Republican party favors fed- 
eral aid in the field, but outside the Social 
Security system. 

The GOP plank pledged : 

"Development of a health program that 
will provide the aged needing it, on a sound 
fiscal basis and through a contributory sys- 
tem, protection against burdensome costs 
of health care. Such a program should : 

" — Provide the beneficiaries with the 
option of purchasing private health insur- 
ance — a vital distinction between our ap- 
proach and Democratic proposals in that it 
would encourage commercial carriers and 
voluntary insurance organizations to con- 
tinue their efforts to develop sound cover- 
age plans for the senior population. 

" — Protect the personal relationship of 
patient and physician. 

" — Include state participation." 

The key paragraph of the Democratic 
plank stated : 

"The most practicable way to provide 
health protection for older people is to use 
the contributory machinery of the Social 
Security system for insurance covering hos- 
pital bills and other high cost medical 
services. For those relatively few of our 
older people who have never been eligible 
for Social Security coverage, we shall pro- 



From the Washington Office of the American Medical As- 
sociation. 



402 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1000 



vide corresponding benefits by appropria- 
tions from the general revenue." 

Charles H. Percy, chairman of the GOP 
Platform Committee, stated that the refer- 
ence to a "contributory system" in the Re- 
publican plank did not mean a Social Se- 
curity tax. 

Presidential and Vice Presidential candi- 
dates of both parties went into the election 
campaigns pledged to support the health- 
care-for-the-aged planks adopted by their 
respective conventions. Vice President Rich- 
ard M. Nixon, the GOP Presidential nom- 
inee, already was on record as unalterably 
opposed to any program of national com- 
pulsory health insurance. The long-estab- 
lished position of Senator John F. Kennedy 
of Massachusetts, the Democratic Presiden- 
tial candidate, has been "that only by use 
of the Social Security system can we have 
true health insurance." 

Speaking for the American Medical As- 
sociation, Dr. Edward R. Annis of Miami, 
Florida, appeared before the platform- 
drafting committee of the Democratic con- 
vention at Los Angeles, and Dr. Leonard 
W. Larson, A.M. A. President-elect, before 
the Republican policy group at Chicago. 

The A.M.A. spokesmen warned both par- 
ties that a program following the Social Se- 
curity approach "would be unpredictably 
costly; it would unnecessarily cover mil- 
lions of people ; it would substitute service 
benefits for cash benefits; it would lead to 
poorer — not better — quality of medical 
care ; it would overcrowd our hospitals ; it 
would lead to the decline, if not the demise, 
of private health insurance ; and it would 
interfere dangerously with the doctor-pa- 
tient relationship, which is the solid foun- 
dation upon which effective medicine must 
be based." 

Dr. Annis also urged support of the 
House-approved Mills plan to provide 
health care for the needy aged who need 
help, with the federal government and the 
states sharing the costs outside the Social 
Security mechanism. 

In an advertisement run in some large 
daily newspapers in mid-August, the A.M.A. 
outlined its reasons for supporting the 
Mills plan. The ad said, in part : 

"The A.M.A. believes our nation, as well 
as its senior citizens, will best be served by 
a locallv administered health aid program 
designed TO HELP THOSE WHO NEED 
HELP . . . 



". . . We are equally sincere in our op- 
position to legislative measures that ap- 
proach the problem on a shotgun basis — 
with the idea of increasing repeatedly the 
Social Security tax in order to finance 
health benefits for EVERYONE who is 
covered by the Old Age, Survivors and Dis- 
ability Insurance program, regardless of 
their need. 

"There are many serious hazards in us- 
ing the Social Security approach to finance 
medical and hospital care for our older 
citizens. When government starts telling 
the doctor how to practice medicine ; telling 
the nurses how to nurse; telling the hos- 
pital how to handle its patients, the qual- 
ity of medical care is sure to decline. The 
cost of such a program eventually would be 
staggering, and would make a serious dent 
in the pay envelopes of millions of Ameri- 
cans covered by Social Security. 

"Most important, perhaps, is the fact 
that such an approach would just be the be- 
ginning of compulsory, government-run 
medical care for every man, woman and 
child in the United States. For it wouldn't 
be long before the Federal Government 
would be lowering the age at which people 
would be eligible, and adding one costly 
services after another to a program that 
would place your health care under the Fed- 
eral Government's thumb. And let's not 
forget that our present health care is recog- 
nized to be the world's finest." 



Attention Medical Doctors 

Our town of 600 pop. and county of 10,000 pop. 
without a doctor. A ready-made practice will 
net $25,000 yearly or more. Our needs are great 
and immediate. Can offer equipped office and /or 
residence for rent. 

If interested, call collect or contact: 

Hugh Harris, Ned Delamar, or Hubert Smith 
Oriental, North Carolina 

(Where hunting, fishing, & boating abound the 
year around) 



1960 

TRANSACTIONS 



OF THE 



AUXILIARY TO THE MEDICAL SOCIETY 

OF THE STATE OF NORTH CAROLINA 



THIRTY-SEVENTH ANNUAL MEETING 

held at 

RALEIGH, NORTH CAROLINA 
MAY 8-11, 1960 



President, Mrs. R. L. Garrard, Greensboro 

Recording Secretary, Mrs. H. D. Riddle, Gastonia 

Treasurer, Mrs. Ralph Deaton, Jr., Greensboro 



—INDEX— 

Auditor's Report 410 General Meeting 408 

Board of Directors' Annual Meeting 404 House of Delegates Annual Meeting 406 

Election of Officers 409 Treasurer's Report 409 



404 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Transactions 
1960-1961 

AUXILIARY TO THE MEDICAL SOCIETY 

of the 

STATE OF NORTH CAROLINA 

Memorial Service, Sunday, May 8, 1960 

The Memorial Service of the Auxiliary to the 
Medical Society of the State of North ' Carolina 
was held Sunday, May 8, 1960, together with the 
Medical Society, in the Elizabeth Room, Sir Walter 
Hotel, Raleigh. Invocation was given by Dr. 
Charles H. Pugh, Chairman of the Committee on 
Necrology, and was followed by the Roll Call of 
the seventy-nine deceased physician-members of 
the Society. 

With words of tribute, Mrs. William P. Richard- 
son, Chairman of the Memorials Committee of the 
Auxiliary to the Medical Society, read the list of 
eight deceased Auxiliary members. 

A choral presentation was given by the Rex 
Hospital Nurses' Choir, under the direction of Dr. 
Frederick S. Smith, Director of Public School 
Music, Raleigh City Schools. The program in- 
cluded "Lord's Prayer", "Holy City", "List to the 
Lark", and "God is Good to All Creation". 

Rev. James G. Huggin, pastor of the First 
Methodist Church, Gastonia, N. C, delivered the 
Memorial address, which was followed by a 
Choral Postlude and the Benediction. 

Deceased Auxiliary Members — 1959-60 

Mrs. George W. Brown, Raeford 

Mrs. A. C. Bulla, Raleigh 

Mrs. J. B. Chandler, Fayetteville 

Mrs L. O. Dunlap, Albemarle 

Mrs. William M. Jones, Gastonia 

Mrs. W. A. Sams, Marshall 

Mrs. Will C. Sealy, Durham 

Mrs. J. N. Taylor, Greensboro 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, 1960 

Finance Committee Meeting — May 9, I960 
Present: President, President-Elect, ' First Vice- 
President, Treasurer, Recording Secretary 

The Finance Committee met for coffee and rolls 
in the President's Suite at 9:15 A.M., May 9, 1960, 
with Mrs. W. Ralph Deaton, Jr., presiding. Mrs. 
Deaton presented the Financial Statement, which 
was accepted, with the addition of notes made on 
attached mimeographed copy. The Tentative Bud- 
get for 1960-61 was accepted with three changes — 
Publicity was reduced to $5.00, By-Laws increased 
to $10.00, and Health Careers increased to $60.00 
(noted on attached copy). These changes did not 
affect the balance of the totals. 

There was discussion on expenses incurred by 
the President in connection with the Yearbook, and 
it was decided that she should be reimbursed. 

There being no further business, the meeting was 
adjourned. 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, I960 

Executive Committee Meeting — May 9, I960 
Present: President, President-Elect, Treasurer, 1st 



Vice-President, Parliamentarian, 2nd Vice-Presi- 
dent, Recording Secretary. 

The Executive Committee met in the President's 
suite, Sir Walter Hotel, at 10:00 A.M., with Mrs. 
R. L. Garrard presiding. 

Mrs. Paul W. Johnson, First Vice-President, 
asked to bring a recommendation to the Board of 
Directors for approval: 

"As 1st Vice-President in charge of Membership 
and Organization, I would like to emphasize the 
importance of this assignment. Increasing mem- 
bership is vital to the strength of the Auxiliary, 
and learning more about the membership and 
various problems is a challenge. Much thougnt and 
imagination are required in fulfilling the functions 
of the 1st Vice-President. It ha-; become increas- 
ingly evident that our officer alignment or "Chain 
of Command" should be made to conform with our 
National Auxiliary, namely die 1st Vice-President 
is an elected officer, frequently succeeding a^ 
President-Elect and President. Thus the duties of 
1st Vice-President could be a forerunner to the 
office of President. In our State Aux. this office is 
automatically filled by the out-going President. It 
is obvious that a thorough knowledge of Member- 
ship and Organization would render a President 
much more effective in her service to the Auxil- 
iary, and she would find this experience more 
helpful before her term as president than after it. 
THEREFORE, as immediate Past-President, I 
recommend that the 1st Vice-President in charge 
of Membership and Organization become a duly 
nominated and elected officer each year. This will 
necessitate a change in the By-Laws, Article 5, 
Section 2." 

(Further) If the 1st Vice-President is to become 
an Elected Officer, then we should consider that 
the out-going President become a Director, serv- 
ing for one year, and she will have full responsi- 
bility for preparing Report Forms for the use of 
Committee Chairmen. These forms are to be pre- 
pared and presented the State President for inclu- 
sion in the Packets at the Fall Board Meeting. 
This would eliminate confusion .incomplete or in- 
adequate report forms, and will make our Nation- 
al reporting much easier. 

After discussion and ruling by the Parliamen- 
tarian, it was decided that this could only be pre- 
sented in the form of a suggestion, to allow the 
lapse of sufficient time before being voted upon. 

There being no further business, the meeting 
was adjourned. 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, 1960 

Board of Directors' Annual Meeting — May 9, 1960 

The 37th Annual Meeting of the Board of Di- 
rectors of the Auxiliary to the Medical Society of 
the State of North Carolina was called to order by 
president, Mrs. R. L. Garrard, at 11: A.M., in the 
Hayes-Barton Room, Sir Walter Hotel, Raleigh. 
Following the invocation by Mrs. Tolbert Wilkin- 
son, a motion was made, seconded and passed to 
dispense with the roll call and reading of the 
minutes. 

Mrs. Garrard introduced Mrs. John M. Chenault, 
president of the Auxiliary to the Southern Med- 
ical Association, and Mrs. Frank Gastineau, pres- 
ident of the Auxiliary to the American Medical 
Association. 

After a few announcements and expressions of 
appreciation, Mrs. Garrard reported that Dr. Ros- 



September, 1960 



AUXILIARY TRANSACTIONS 



405 



coe McMillan, Chairman of the Advisory Commit- 
tee of the State Medical Society, would not be 
with us at that time, due to a conflicting meeting, 
but would be present later. Dr. John C. Reece. 
President of the Medical Society, was also unable 
to be present, but sent greetings in the form of a 
letter, which was read by the Recording Secretary, 
(attached) 

Supplemental Reports, bringing the work of the 
Auxiliary up to May 1, were distributed. 

Mrs. Paul P. McCain, Chairman of Past Presi- 
dents, introduced the past presidents, of whom 14 
were present as follows: 

Mrs. Benjamin J. Lawrence, Raleigh 
Mrs. A. Byron Holmes, Fairmont 
Mrs. William P. Knight, Greensboro 
Mrs. Charles P. Eldridge, Raleigh 
Mrs. Sidney Smith, Raleigh 
Mrs. Karl B. Pace, Greenville 
Mrs. W. Reece Berryhill, Chapel Hill 
Mrs. Watson B. Roberts, Durham 
Mrs. Roscoe D. McMillan, Red Spring 
Mrs. Powell G. Fox, Raleigh 
Mrs. R. B. Croom, Jr., Maxton 
Mrs. Donnie M. Royal, Salemburg 
Mrs. Paul W. Johnson, Winston-Salem 
Mrs. Gilbert M. Billings, Moiganton 
Mrs. McCain also reported that she and the 
other past presidents usually have lunch together, 
and that they have among themselves a floating 
fund which is sent to various places, wherever 
needed. Last year it was $150.00, and at present 
is at the UNC Medical School. 

1ST VICE-PRESIDENT— Mrs. Paul W. Johnson 
introduced the District Councilors, of whom four 
were present, one being a substitute. She then 
asked everyone to look at page 17 of the Annual 
Repor-ts, and give close attention to her suggestion 
there. The Recording- Secretary was asked to read 
the following- addendum in connection with this: 

"If the 1st Vice-President is to become an 
Elected Officer, then we should consider that the 
out-going President become a Director, serving for 
one year, and she will have full responsibility for 
preparing Report Forms for the use of Committee 
Chairmen. These forms are to be prepared and 
presented to the State President for inclusion in 
the Packets at the Fall Board Meeting. This would 
eliminate confusion, incomplete or inadequate re- 
port forms, and will make our National reporting 
much easier." 

The President asked that we give this careful 
consideration, saying that it will come up as a 
recommendation next fall at the Board Meeting. 

At this time, Mrs. McCain suggested that the 
wife of the President of the Medical Society should 
be made an honorary member of the Board of 
Directors, so that at future meetings when the 
President cannot attend personally, his wife can 
bring his greetings. She pointed out that such a 
move would make for a more personal relationship 
between the Medical Society President and our 
Board of Directors. This suggestion will also come 
up as a motion at the Fall Board Meeting. 

2ND VICE-PRESIDENT— Mrs. Charles D. Thom- 
as, introduced the Chairmen of the Sanatoria Bed 
Funds, and called attention to the fact that these 
funds had been started at the suggestion of Mrs. 
McCain. 

TREASURER— Mrs. W. Ralph Deaton, Jr., 
passed out copies of the Financial Statement, and 
the Tentative Budget for 1960-61. She called at- 
tention to the amount for the Yoder Bed, which 
might seem unduly high compared to the others, 
and explained that the Cooper Bed patient had 
been transferred to the Yoder Bed for surgery, 



and that the Cooper Bed would remain empty till 
this patient returned to it. The Treasurer's report 
and tentative budget were accepted and placed on 
file. 

Other officers present were recognized. 
Committee Chairmen 

AMEF Chairman, Mrs. Bruce B. Blackmon, made 
a correction in the Supplemental Report, stating 
that contributions totalled $1944.25 instead of 
$2108.25. 

"Auxiliary News" Chairman, Mrs. Walter G. 
King, was absent, but the President pointed out 
that the "News" is now being used as a means of 
communication and education as well as news, and 
expressed hope that the group at large approved 
and appreciated this. This Chairman plans to move 
up the deadline for "News" reports to the 10th 
instead cf the 15th, of June, September, December, 
and March. 

Awards Chairman, Mrs. Powell G. Fox, had no 
announcements at this time. 

Civil Defense Chairman, Mrs. Amos N. Johnson, 
noted on3 addition to the supplemental report, 
flaga 3 — that Cumberland County Aux. had taken 
First Aid and Nursing courses. 

Community Health Chairman, Mrs. Robert N. 
Creadick, was absent, but sent a suggestion 
through Mrs. Hitch that the committees of Com- 
munity Health and Community Service might well 
be combined. This will come up for consideration 
later, after due study. 

Legislation Chairman, Mrs. W. Jack Hunt, ex- 
pressed great appreciation for the work done this 
year, work that she considered outstanding. 

Memorials Chairman, Mrs. W. P. Richardson, re- 
ported the deaths of eight members during the 
year. 

Paramedical Careers Recruitment Chairman, 
Mrs. A. J. Crutchifeld, reminded us that this com- 
mittee's name will probably be changed to Health 
Careers. This will come up at the National meet- 
ing for decision, and we will conform to the Na- 
tional designation. 

Program Committee Chairman, Mrs. D. S. Cur- 
rie, Jr., had no report except to say that there will 
be a change in report forms next year. 

S.A.M.A. Chairman, Mrs. W. Reece Berryhill, 
reported that the two main active areas in this 
field are Forsyth-Stokes and Durham-Orange, and 
the one officially affiliated group at this time is at 
Duke. 

Today's Health Chairman was absent, but Mrs. 
Garrard reported that we had at least 450 sub- 
scriptions above those reported before Project 60 
was announced, and more were expected. At this 
point, Mrs. Gastineau discussed Project 60 briefly, 
saying that the national organization was very 
grateful for these extra subscriptions, and that she 
thought probably N. C. did best of all in this. 

Representatives to other state organizations 
were recognized. 

Nominating Committee for 1960-61, in accord- 
ance to the By-Laws, was appointed as follows: 

1. Mrs. R. L. Garrard, 8th District 

2. Mrs. Lenox Baker, 6th Distict 

3. Mrs. Baxter Troutman, 9th District 

4. Mrs. Eugene Clayton, 10th District 

5. Mrs. W. E. Keiter, 2nd District 
and two alternates: 

1. Mrs. Phil Ban-inger, 7th District 

2. Mrs. Donnie Royal, 3rd District 
Old Business 

Mrs. Garrard commented on the five Recommen- 
dations, made and passed at the Fall Board Meet- 
ing, which will be presented to House of Delegates. 



106 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



New Business 

The President reminded us of the Nominating 
Committee changes, published in the Auxiliary 
News, and had this read in full by By-Laws Com- 
mittee Chairman, Mrs. Tolbert Wilkinson, (at- 
tached) A motion was made, seconded and passed, 
to adopt these changes. 

Mental Health Chairman, Mrs. A. M. Lang, was 
asked to read the following recommendation ap- 
proved at the Fall Board Meeting: 

"The Mental Health Committee, as authorized 
by the Board at the Fall Board Meeting on Sep- 
ember 9, has been working through the details of 
setting up a new Mental Health Project for the 
Auxiliary. We are prepared at this time to make 
the following recommendations: 

"That the Auxiliary to the Medical Society of 
the State of North Carolina set up an Endowment 
Fund in the minimum amount of $10,000, the pro- 
ceeds of which are to be used by the Psychiatric- 
Department of Memorial Hospital, University of 
North Carolina, for research and training pur- 
poses. The money is to be disbursed by the Treas- 
urer annually, and is to be used at the discretion of 
the Director of the Department of Psychiatry for 
any needed purpose in the field of research, in the 
training of psychiatric personnel, or in the care 
of patients maintained in the hospital for training 
and research purposes. The Auxiliary does not wish 
to dictate how this money will be used, but will 
wish to have an annual report on how the money 
has been spent. It will take several years to build 
up sufficient funds to be of much value, and it is 
understood that the Auxiliary's financial contribu- 
tion may be added to existing funds for research 
or training projects. 

"A Chairman is to be appointed to handle this 
new Mental Health Endowment Fund, and she will 
work under the 2nd Vice-President (Chairman of 
Activities). An amendment to the By-Laws, Arti- 
cle VI, Section 4 and Article VIII, Section 3(b) 
and Section 4, will be necessary. Additions will be 
required to Article XI and Article XIV, Section 3. 

"It is noted that there is a very urgent need for 
funds such as the new Mental Health Endowment 
Fund would provide. The assistance of the Auxil- 
iary has been requested, the Advisory Committee 
of the State Medical Society has expressed its 
wholehearted support. It is further noted that the 
Yoder Bed Endowment Fund is essentially com- 
pleted, and the Auxiliary is ready to undertake a 
new long-term project." 

The name of the fund shall be the Auxiliary to 
the N. C. Medical Society Mental Research Fund." 

The motion, formed from the first sentence, 
second paragraph of above quote, was made, 
seconded, and passed. 

At this point, Mrs. W. Jack Hunt, Legislation 
Chairman, requested the floor, to express her per- 
sonal appreciation and pleasure in working this 
year with our wonderful President, Mrs. Garrard. 
This was soundly appoved by the group with great 
applause. 

Mrs. Garrard then introduced Mrs. Frank Gas- 
tineau, President, Auxiliary to the American Med- 
ical Association. Mrs. Gastineau said that she 
picked N. C. to visit because she wanted to pay 
tribute to the Auxiliary that was the "best organ- 
ized in the United States". She pointed out that 
we have 80 r ;'r of potential membership, and Arkan- 
sas is the only other state that has as much, but 
it is much smaller. Among other things, she em- 
phasized that the main thing we MUST do is to 
keep up with current legislation, and that we must 
try to reverse the trend of reckless government 



spending, and the gradual limiting of our freedoms. 
After her inspiring message, the meeting was 

adjourned. 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, 1960 

House of Delegates Annual Meeting — May 10, I960 

The 37th Annual Meeting of the House of Dele- 
gates of the Auxiliary to the Medical Society of 
the State of North Carolina met in the Virginia 
Dare Room at the Hotel Sir Walter, Tuesday, May 
10, 1960, at 9:00 A.M. Mrs. R. L. Garrard, Presi- 
dent, called the meeting to order, and the invoca- 
tion was given by Mrs. William P. Richardson. A 
motion was made, seconded, and passed, to dis- 
pense with the Roll Call and the leading of the 
Minutes. 

The Convention Chairman, Mrs. Paul E. Simp- 
son, welcomed the group to Raleigh, asked us to 
please check programs again to be sure about the 
bus schedules for lunch and the tea, and reminded 
us that the hour for the Banquet was to be 6:30 
promptly. 

Mrs. Garrard expressed appreciation to Mrs. 
Simpson and her Convention hostesses for the 
hours of hard work and preparation they had 
spent. 

At this point, in the absence of the 1st Vice- 
President, the President asked Mrs. Donnie Royal, 
a past President, to take the chair, so that she 
might give her President's Report (attached), 
which was somewhat of a precis of the report 
given with other annual reports, and essentially 
the same report she had given to the Medical So- 
ciety House of Delegates. 

Report of Officers 

Mrs. Paul McCain, Chairman of Past Presidents, 
introduced those Past Presidents who were pre- 
sent, 16 in number, as follows: 

Mrs. Paul P. McCain, Wilson 

Mrs. A. Byron Holmes, Fairmont 

Mrs. William P. Knight, Greensboro 

Mrs. Charles P. Eldridge, Raleigh 

Mrs. Charles F. Strosnider, Goldsboro 

Mrs. Sidney Smith, Raleigh 

Mrs. Robert A. Moore, Winston-Salem 

Mrs. Karl B. Pace, Greenville 

Mrs. W. Reece Berryhill, Chapel Hill 

Mrs. B. Watson Roberts, Durham 

Mrs. Roscoe McMillan, Red Springs 

Mrs. G. M. Billings, Morganton 

Mrs. P. G. Fox, Raleigh 

Mrs. R. D. Croom, Jr., Maxton 

Mrs. Donnie Royal, Salemburg 

Mrs. Paul Johnson, Winston-Salem 

Mrs. Paul Johnson, 1st Vice-President, intro- 
duced District Councilors, who in turn introduced 
County Presidents and Presidents-Elect who were 
present, (see attached program) NOTE — 9th Dis- 
trict will soon have one new county organization, 
Davidson, and with the organization of Duplin 
County, the 3rd District will now be 100%. 

2nd Vice-President, Mrs. Charles D. Thomas, 
thanked the group for all gifts to Sanatoria Bed 
guests, and for cooperation throughout the year-. 
She then introduced the Sanatoria Bed Chairmen, 
none of whom were present, and Student Loan 
Fund Chairman, Mrs. Roscoe McMillan. Mrs. Mc- 
Millan thanked the various counties for their in- 
terest and work, and stated that this was certain- 
ly the best year yet for the Student Loan Fund. 



September, 1960 



AUXILIARY TRANSACTIONS 



407 



Other officers were recognized — Recording Secre- 
tary, Mrs. H. D. Riddle; Corresponding Secretary, 
Mrs. Marvin McRae; Treasurer, Mrs. W. Ralph 
Deaton, Jr. Mrs. Deaton at this po nt noted one 
explanation of the Financial Statement. (See at- 
tached form) 

Committee Chairmen were recognized according 
to the mimeographed agenda. 

Civil Defense Chairman Mrs. Amos Johnson, 
asked everyone to pick up Civil Defense material 
outside, to take home, and said some of this ma- 
terial would be available in the packets at the 
Fall Board Meeting-. 

Memorials Chairman Mrs. William P. Richard- 
son asked the group to stand in tribute to the 
eight deceased members, and read the names. (See 
Memorial Service Minutes.) 

Representatives to other state organizations 
were recognized. (See Program) 

Treasurer, Mrs. W. R. Deaton, Jr., presented the 
tentative budget, with three changes. (See Finan- 
cial Committee Minutes) The motion was made by 
Mrs. Deaton, seconded by Mrs. Marvin McRae, and 
passed, to accept this budget. 

Old Business 

The President asked the Recording Secretary to 
read six recommendations from the Board of Di- 
rectors, to be voted upon separately, as follows: 

1. That, to avoid duplication, the Program Com- 
mittee and the Radio TV and Movies Committee 
be combined, this combining- of committees to be- 
come effective at the end of the present Chairmen's 
terms, May, 1961. Further recommended that the 
section on Committees in the By-Laws, Article 
XIV, Section 2, be amended accordingly. Motion to 
accept was made by Mrs. Lawrence Owsley, sec- 
onded by Mrs. A. T. Melero, and carried. 

2. That the Today's Health Committee be dis- 
continued at the end of the present Chairman's 
term, May, 1961, since the National Auxiliary had 
discontinued the sale of Today's Health Magazine 
as a major project. Further recommended that this 
Committee be deleted from the By-Laws, Article 
XIV, Section 2. Motion was made by Mrs. Roy M. 
Smith, seconded by Mrs. J. F. McGowan, and was 
passed. 

3. That the qualifications for the office of Pres- 
ident of the Auxiliary to the Medical Society of 
the State of North Carolina shall be more clearly 
defined, stating that the President must have 
served her County Auxiliary as president, and 
must have served on the State Board of Directors 
for a period of three (3) years, as an officer, com- 
mittee chairman, councilor, or any combination of 
these. Motion was made by Mrs. A. Byron Holmes, 
seconded by Mrs. C. M. Norfleet, and was passed. 

4. That the duties of the President-Elect be more 
clearly defined, and these shall include the prepar- 
ation and typing of the Master Lists of all county 
Auxiliary officers and chairmen, with specific- 
breakdowns for Councilors, Committee Chairmen 
and Treasurer; she shall keep up to date the card 
file of all Auxiliary members in the State, record- 
ing- any change in the member's status, offices held, 
etc.; and that she be charged with the responsi- 
bility of conducting the Workshop sessions held at 
the Fall Board Meeting each year, working in 
close cooperation with the President. It is to be 
noted that the President-Elect has been carrying- 
out all these functions, but this recommendation 
is intended to include them in her official duties so 
that she may more fully prepare herself for the 
office of President. Motion was made by Mrs. Paul 
Johnson, seconded by Mrs. W. P. Richardson, and 
was passed. 



5. That a complete revision of the By-Laws be 
undertaken, beginning in 1960, with special refer- 
ence to the duties of officers, line of succession, 
etc.; this is to be undertaken to incorporate the 
various changes outlined in previous Recommen- 
dation of the Executive Committee, to facilitate the 
work of the State Auxiliary, and to take advantage 
of valuable suggestions made by the National Aux- 
iliary. It is suggested that the By-Laws Commit- 
tee work in close cooperation with the Legal De- 
partment of the State Medical Society. Motion was 
made by Mrs. A. T. Melero, seconded by Mrs. Bax- 
ter Troutman, and was passed. 

New Business 

The Recording Secretary read the following 
recommendation which had been published in 
"Auxiliary News": 

6. The Executive Committee of the Aux. to the 
Medical Society of the State of N. C, in accord- 
ance with the By-Laws, presents the proposed 
changes in the By-Laws, subject to the approval 
by vote of the House of Delegates: Section 5 — 
There shall be a Nominating- Committee consisting 
of five members and two alternates, as follows: 

a. Two of the five members shall be past pres- 
idents, with the immediate past president auto- 
matically becoming a member of the Nominating 
Committee and serving as Chairman. 

b. The remaining members shall be elected and 
no two may come from the same district. 

c. The Nominating Committee shall be elected 
at the Board Meeting immediately preceding the 
Annual Meeting. 

d. The Nominating Committee shall confer and 
come to an agreement before asking anyone to 
serve, and shall obtain the consent of all nominees 
before presenting their names. Nominations shall 
be permitted from the floor. 

The above change combines Section 5 and Sec- 
tion 6 of the By-Laws, and places the immediate 
past president on the Nominating Committee, to 
serve as Chairman, and includes one additional 
past president. Motion was made by Mrs. Z. F. 
Long, seconded by Mrs. Lawrence Owsley, and 
was passed. 

The President then asked the Recording Secre- 
tary to read in full the report and recommenda- 
tions from the Mental Health Committee (See 
Minutes of Board of Directors Meeting). Motion 
was made by Mrs. Roscoe McMillan, seconded by 
Mrs. Henry Sikes, and was passed. (During dis- 
cussion, before above motion was passed, Mrs. Gar- 
rard replied to a question, that the reason the 
University of N. C. was chosen to handle this en- 
dowment fund, was that it is a state-supported 
university, and we are a state organization.) 

Immediately after motion was carried, Mrs. Roy 
Smith, Guilford-Greensboro Branch, asked for the 
floor. She said that her county Auxiliary — and Mrs. 
Garrard's — wanted to contribute $100.00 as the be- 
ginning of this Mental Health Endowment Fund. 
The President very graciously accepted this con- 
tribution. 

The Recording- Secretary was then asked to read 
in full a suggestion from the 1st Vice President, 
Mrs. Paul Johnson: 

"As 1st Vice President in charge of Membership 
and Organization, I would like to emphasize the 
importance of this assignment. Increasing mem- 
bership is vital to the strength of the Auxiliary, 
and learning- more about the membership and 
various problems is a challenge. Much thought and 
imagination are required in fulfilling the func- 
tions of First Vice President. It has become in- 
creasingly evident that our officer alignment or 
'Chain of Command' should be made to conform 



in,; 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



with our National Auxiliary, namely the First 
Vice-President is an elected officer, frequently suc- 
ceeding as President-Elect and President. Thus the 
duties of First Vice-President could be a forerun- 
ner to the office of President. In our State Auxil- 
iary, this office is automatically filled by the out- 
going President. It is obvious that a thorough 
knowledge of Membership and Organization would 
render a President much more effective in her 
service to the Auxiliary, and she would find this 
experience more helpful before her term as pres- 
ident than after it. Therefore, as immediate Past- 
President,I suggest that the First Vice-President in 
charge of Membership and Organization become a 
duly nominated and elected officer each year. This 
will necessitate a change in the By-Laws, Article 
5, Section 2." 

(Further) If the First Vice-President is to be- 
come an Elected Officer, then we should consider 
that the out-going President become a Director, 
serving for one year, and she will have full re- 
sponsibility for preparing Report Forms for the 
use of Committee Chairmen. These forms are to 
be prepared and presented to the State President 
for inclusion in the Packets at the Fall Board 
Meeting. This would eliminate confusion, incom- 
plete or inadequate report forms, and will make 
our National reporting much easier." 

Mrs. Garrard stated that this suggestion would 
come up at the Fall Board Meeting for considera- 
tion as a recommendation. 

She also mentioned that she had asked Dr. 
Reece, President of the Medical Society, to bring 
up, if possible, a recommendation before the Med- 
ical Society, to change the name of the society to 
"N. C. Medical Society", so that our own official 
title would be less unwieldy. 

In the absence of any other business, the meet- 
ing was then adjourned, and a coffee and Coca- 
Cola break was enjoyed. 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, 1960 

General Meeting 
May 10, 1960 

The 37th Annual General Meeting of the Aux- 
iliary to the Medical Society of the State of North 
Carolina convened at 10:30 A.M., in the Virginia 
Dare Room of the Hotel Sir Walter, Raleigh, with 
the President, Mrs. R. L. Garrard presiding. The 
Invocation was given by Mrs. William P. Knight, 
followed by the Auxiliary Pledge of Loyalty, with 
all participating. 

A most gracious welcome was given by Mrs. 
Thomas B. Wilson, President of Wake County 
Auxiliary, followed by a humorous and apprecia- 
tive response by Mrs. Roy M. Smith, President of 
Guilford-Greensboro Auxiliary. 

The President also expressed her gratitude for 
the tremendous work of preparation that our hos- 
tesses had done. 

The Convention Chairman, Mrs. Paul Simpson, 
reminded us of the bus schedules for the luncheon 
and the tea. She also stated that at last count, 
here were 255 Auxiliary members registered. 
_ Mrs. Garrard regretted that Mrs. Frank Gas- 
tineau, President of the Auxiliary to the American 
Medical Association, had had to leave the previous 
night, so could not be with us. She then introduced 
other distinguished guests: Mrs. John M. Chenault, 
President of the Auxiliary to Southern Medical 
Association; Miss Martha Adams, President of the 



N. C. State Nurses' Association, who spoke brief- 
ly and extended greetings; Miss Agnes Campbell. 
1st Vice-President (substituting for Miss Sue Ker- 
ley, President) of N. C. League for Nursing; Mrs. 
Mary K. Kneedler, Chief of Public Health Nursing, 
N. C. Public Health Department; Dr. Jean Brooks, 
member of the Advisory Committee of the Med- 
ical Society, was not present, nor were Mrs. An- 
nette Boutwell, Mrs. James Barnes, nor Mrs. Wil- 
liam Hilliard. 

Dr. Roscoe McMillan, Chairman of the Advisory 
Committee, was unable to be present, as was Dr. 
John Reece, President of the Medical Society. Dr. 
Reece sent greetings in the form of a letter, which 
was read by the Recording Secretary. (Attached to 
Minutes of Board of Directors' Meeting) 

Stanly County President, Mrs. George E. Eddins, 
Jr., asked her local AMEF Chairman, Mrs. L. H. 
Harris, to tell the group about a money-making 
project for AMEF that they were planning. Mrs. 
Harris said, however, that these plans were still 
incomplete. Mrs. Garrard asked that when they 
had worked out the details, they bring them to the 
Fall Board Meeting, so that we might all have the 
benefit of any new ideas. 

The President at this time pointed out that this 
was National Hospital Week. 

She then introduced, for a delightful entertain- 
ment, a chorus from the Guilford County Auxil- 
iary — Greensboro Branch, 22 singers who were all 
Auxiliary members. The group was directed by 
Mrs. John W. Allgood, and accompanied by Mrs. 
H. B. Perry. Their numbers were "Get Me to the 
Church on Time", "I Could Have Danced All 
Night", "Three Blind Mice", "Lady of Spain", 
"The Cuckoo Clock", and "All the Things You 
Are". This was an unusually good rendition, and 
all the more enjoyable because of the singers' be- 
ing Auxiliary members. 

Mrs. Karl B. Pace introduced the Past Presi- 
dents, of whom the following 16 were present: Mrs. 
Paul P. McCain, Wilson; Mrs. A. Byron Holmes, 
Fairmont; Mrs. William P. Knight, Greensboro; 
Mrs. Charles P. Eldridge, Raleigh; Mrs. Charles 
F. Stronsnider, Goldsboro; Mrs. Sidney Smith, 
Raleigh; Mrs. Robert Moore, Winston-Salem; Mrs. 
Karl B. Pace, Greenville; Mrs. W. Reece Berryhill, 
Chapel Hill; Mrs. B. Watson Roberts, Durham; 
Mrs. Roscoe McMillan, Red Spring; Mrs. G. M. 
Billings, Morganton; Mrs. Powell G. Fox, Raleigh; 
Mrs. R. D. Croom, Jr., Maxton; Mrs. Donnie M. 
Royal, Salemburg; Mrs. Paul Johnson, Winston- 
Salem. 

Mrs. Garrard then introduced Mrs. John M. Che- 
nault, President, Auxiliary to Southern Medical 
Association, of Decatur, Alabama. She reported 
that there are 948 N. C. doctors now members of 
the Southern Medical Association, and suggested 
that the gift of a membership for our husbands 
would be good idea for any occasion. The annual 
convention of SMA will be in St. Louis on October 
31. She advised that "Love is the most essential 
gift a doctor's wife should have, both for our fel- 
low man, and for the profession of medicine," and 
that it would help us to fight off the "demons of 
jealousy, selfishness, and criticism." She finished 
her inspiring talk with the quotation, "It is not 
the height of the mountain that deters the climber, 
but rather the tack in his shoe", and urged us to 
"get the tacks out". 

Mrs. Garrard called upon Mrs. James F. Rein- 
hardt. Community Service Chairman, who was in 
charge of the program, "We Did It Like This". 
Mrs. Reinhardt pointed out that although the 
mimeographed Annual Reports enable us to get a 
good overall idea of the work being done, some- 



September, 1960 



AUXILIARY TRANSACTIONS 



409 



times perhaps we miss the personal enthusiasm 
and intimacy of the county workers. So this pro- 
gram was planned to let some of these workers 
tell us how they had accomplished certain goals. 
These representatives were from both large and 
small organizations. 

For AMEF, Mrs. A. B. Croom, President of 
Guilford County-High Point Branch, said they in- 
creased their contribution from $50.00 to $150.00, 
simply by increasing their dues $2.00 each. 

For Doctors' Day, Alamance-Caswell Auxiliary 
(small), as told by Mrs. J. H. Hawkins, President, 
gave their own production of "Gigi", with words 
and parodies borrowed from Forsyth-Stokes' per- 
formance last year, and augmented to suit their 
own group. 

For Doctors' Day Guilford County-Greensboro 
Branch (over 50 members), as told by Mrs. Roy 
M. Smith, President, had a buffet dinner in the hall 
of one of the new churches, and entertainment was 
provided by the Chorus from their own Auxiliary. 
The retired doctors of the county were special 
guests of honor. 

Mrs. W. L. Kirby, from Forsyth-Stokes Auxil- 
iary, told of their work in Mental Health, with 
special reference to their work with the aged. Mrs. 
Chalmer R. Carr, Mecklenburg Auxiliary, told of 
their Paramedical Careers Recruitment work, 
which they worked in with a Hospital Career Day, 
for local students, etc. Mrs. H. M. Wilson (sub- 
stituting for Mrs. Len D. Hagaman), President- 
Elect of Watauga County, described their methods 
of earning money for the Student Loan Fund. 
Mrs. James E. Ribet, substituting for Mrs. J. Tay- 
lor Vernon, Burke County, told about their fund 
raising for the Yoder Bed Endowment Fund. 

After this informative program, Mrs. Garrard 
asked Mrs. Powell G. Fox to present the awards 
for the year's work. Mrs. Fox then said that the 
program we had just heard had told us mostly 
where the awards were going. They were as fol- 
lows: 

1. AMEF — The Shirley Kingsbury Fox "Talents 
for Service Award", given by Mrs. P. G. Fox — 
$100.00. 

For highest per capita contribution — Guilford- 
High Point Branch 

Also, certificates to Forsyth-Stokes for largest 
contribution, and Cabarrus for outstanding in- 
crease. 

2. Doctors' Day — given by Mrs. Harvey C. May 
County with over 50 members — $5.00 — Guilford- 
Greensboro Branch 

County with under 50 members — $5.00 — Ala- 
mance-Caswell 

3. Paramedical Careers Recruitment — the Rachel 
Taylor Award, given by Mrs. Almon R. Cross 
County with over 30 members — $5.00 — Mecklen- 
burg 

County with under 30 members — $5.00 — Anson 

4. Dues 100% paid (first) — given by Mrs. G. M. 
Billings 

Award — $5.00 — to Union County 
Honorable mention to Bladen County 

5. Research and Romance of Medicine — given by 
Mrs. Donnie Royal — no candidates for this award, 
so it will be held over till next year. 

6. Student Loan Fund — given by Mrs. Roscoe D. 
McMillan and Mrs. B. Watson Roberts— $10.00— to 
Watauga County 

7. Mental Health — given by Mrs. Karl B. Pace— 
$5.00— to Forsyth- Stokes 

8. Yoder Bed Endowment Fund — given by Mrs. 
R. D. Croom, Jr.— $5.00— to Burke County 

9. County Yearbook — given by Mrs. Baxter S. 
Troutman — $5.00 — to Robeson County 



10. The President's County Achievement Award 
for the Best Overall Work — given by Mrs. R. L. 
Garrard— $10.00— to Gaston County 

The President now asked for the report of the 
Nominating Committee, and Mrs. A. Byron 
Holmes, Chairman, gave it as follows: 

President-Elect — Mrs. George T. Noel, Kannap- 
olis 

Second Vice-President — Mrs. James F. Rein- 
hardt, Durham 

Treasurer — Mrs. W. Ralph Deaton, Jr., Greens- 
boro 

The floor was then opened to nominations, of 
which there were none. The motion was made by 
Mrs. Byron Holmes to accept the slate as read, 
seconded by Mrs. Lawrence Owsley, and passed 
unanimously. 

Mrs. Paul P. McCain, assuming her traditional 
role, then installed the following officers for 1960- 
61: President, Mrs. J. M. Hitch; President-Elect, 
Mrs. George T. Noel; 2nd Vice-President, Mrs. 
James F. Reinhardt; Treasurer, Mrs. W. Ralph 
Deaton, Jr. 

Mrs. Garrard, with congratulations, presented 
the gavel to Mrs. Hitch, who made a few inaug- 
ural remarks, and pinned the Past President's Pin 
on Mrs. Garrard. Mrs. Hitch announced that the 
Fall Boad Meeting will be in Raleigh on September 
7. She also recognized Mrs. E. Clarence Judd, who 
was our Treasurer for 20 years. Final registration 
was 338. 

With no other business, the meeting was ad- 
journed. 

Mrs. H. D. Riddle 
Recording Secretary 

Mrs. R. L. Garrard 

President 

Date: June 3, 1960 

Report of the Treasurer 

The Audited Report of the Treasurer's records 
for the year 1959-1960 is submitted herewith, re- 
ceipts and disbursements having been recorded 
and transactions made in accordance with the By- 
laws. 

A membership of 2,279 was attained in 1959- 
1960 which is 14 less than last year due to two 
counties becoming inactive. 

The financial picture of the Auxiliary is stable. 
A change has been made in the handling of the 
Contingency Fund which was in the checking ac- 
count. The Auxiliary now holds a savings account 
repi-esenting share interests of two thousand dol- 
lars ($2,000) in the Home Federal Savings and 
Loan Association of Greensboro. We will receive 
4 f /r interest on this amount annually. 

This year we were notified by the United States 
Treasury that two of our bonds in the Stevens En- 
dowment Fund were to mature in July 1960 and 
that we were to be given the opportunity to rein- 
vest these bonds in United States marketable 
bonds which would yield 4% % interest. We took 
advantage of the opportunity although up to this 
time we have only invested in savings bonds. 

At this time we are $534.26 short of completing 
the $10,000 Paul Allison Yoder Endowment Fund. 
We have $7500 in Savings Bonds and $1,965.74 in 
the Home Federal Savings and Loan Association 
of Greensboro. 

During the year we issued student loans in the 
amount of $2500 which brings the total of our 
loans to $5000. We have already received requests 
for more loans, which if issued, will exhaust our 
Student Loan Fund until we receive more contri- 
butions or paid up loans. 

(Continued on page 414) 



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414 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



We were delighted to set up another endowment 
fund called the Mental Research Fund. Greensboro 
Branch of Guilford County Medical Auxiliary 
started the fund off by contributing $100.00. This 
has been placed in a savings account in Home 
Federal Savings and Loan Association. 

My job as Treasurer was considerably easier 
this year due in part to having now had some ex- 
perience at the job and in part to recommenda- 
tions from the Auditor who suggested changes that 
made the bookkeeping easier. 



As experienced the first year as Treasurer, hav- 
ing had the opportunity of working with every 
member of the Executive Board has been a very 
worthwhile experience, and I would like to thank 
them for all their help and cooperation. My thanks 
go also to Mr. James T. Barnes and to each mem- 
ber of his staff for their help at the Convention 
and to Dr. R. D. McMillan and Dr. Jean Brooks 
for their interest in the welfare and activities of 
the Auxiliary. 



ROSTER OF MEMBERS 
1960-1961 



HONORARY MEMBERS 

Holmes, Mrs. Andrew Bvron 

112 Church Street Fairmont 

Judd, Mrs. E. Clarence 

2108 Woodland Ave Raleigh 

Knight, Mrs. William Pinkney 

720 Summit Ave Greensboro 

McCain, Mrs. Paul Presslv, Route 1, Box 31, Wilson 
Taylor, Mrs. Frederick R. 

1113 Johnson St High Point 

LIFE MEMBERS 

Britt, Mrs. James Norment 

209 E. 10th St Lumberton 

Eldridge, Mrs. Charles Patterson, 

1621 St. Mary's St Raleigh 

Freeman, Mrs. Jere David 

527 Forest Hills Dr Wilmington 

Johnson, Mrs. George W. 

1803 Chestnut St Wilmington 

Murray, Mrs. Robert Lebby, Box 216 Raeford 

Thomas, Mrs. Charles Darwin Black Mountain 

Yoder, Mrs. Paul A. 

1919 Robin Hood Rd Winston-Salem 

MEMBERS 

Abbott, Mrs. Robert West 

State Hospital Goldsboro 

Abernethy, Mrs. Joseph Whitner 

343 Second St., N. W Hickory 

Abernethy, Mrs. Paul McBee 

510 Count-y Club Dr Burlington 

Acuff, Mrs. Calvin Clifford Glen Alpine 

Adair, Mrs. William Edward, Jr. 

502 East G St Erwin 

Adams, Mrs. Carlisle 

1500 Meadowood Lane Charlotte 

Adams, Mrs. Carlton Noble 

2930 Windsor Rd Winston-Salem 

Adams, Mrs. Charles H Grover 

Adams, Mrs. Charles Patrick 

1907 Forest Hill Dr Greenville 

Adams, Mrs. Harley Stewart 

432 Carolina Circle Winston-Salem 

Ader, Mrs. Ottis Ladeau Walkertown 

Aderholt, Mrs. Marcus Lafayette, Jr. 

1013 Rotary Dr High Point 

Adkins, Mrs. Trogler Francis 

2810 Dogwood Rd Durham 

Agner, Mrs. Marshall Edward, Box 157, Cherry ville 
Agner, Mrs. Rov Augusta, Jr. 

400 Merritt Ave Salisbury 

Akeson, Mrs. Wayne H. 

21 Flemington Rd. ..... Chapel Hill 

Albergotti, Mrs. Julian S., Jr. 

412 Livingston Dr Charlotte 



Alderman, Mrs. Allison Mondonville, Jr. 

1311 Westfieki Ave Raids".. 

Alderman, Mrs. Edward H., Drawer P, Four Oaks 
Alexander, Mrs. Eben, Jr. 

521 Westover Ave Winston-Salem 

Alexander, Mrs. James Moses 

255 Colville Rd Charlotte 

Alexander, Mrs. James Porter 

1910 Beverly Dr Charlotte 

Alexander, Mrs. Joseph Black 

1001 N. Walnut St Lumberton 

Alexander, Mrs. Lawrence M Sanford 

Alexander, Mrs. Sydenham B. 

511 Dogwood Dr Chapel Hill 

Alexander, Mrs. William McKinley 

1110 Fourth Ave., West Hendersonvillc 

Allen, Mrs. Charles Insley, Sr Wadesboro 

, Allen, Mrs. George Calvin, 

206 E. 17th St Lumberton 

Allen, Mrs. John O. Henrv, 201 Broad St., Marion 

Allen, Mrs. LeRoy, 1603 Ridge St Raleigh 

Allgood, Mrs. John William, Jr. 

105 Knolhvood Dr Greensboro 

Alsup, Mrs. William Byrn, Jr. 

261 Westview Dr Winston-Salem 

Altany, Mrs. Franklin Edward 

822 Longbow Rd Charlotte 

Alvea, Mrs. Edwin Pascal 

3102 Devon Rd., Hope Valley Durham 

Ames, Mrs. Richard Haight 

2316 Princess Ann St Greensboro 

Anders, Mrs. McTyeire Gallant 

416 W. 5th Ave Gastonia 

Anderson, Mrs. Elbert Carl 

4934 Oleander Dr Wilmington 

Anderson, Mrs. John Bascom 

294 Vanderbilt Rd Asheville 

Anderson, Mrs. Norman LaRue 

33 Forest Road Asheville 

Anderson, Mrs. William Banks 

502 E. Forest Hills Blvd Durham 

Andrew, Mrs. John Montgomery 

Box 524 Lexington 

Andrew, Mrs. Lacv Allen, Jr. 

2839 Reynolds Rd Winston-Salem 

Andrews, Mrs. Bob Barcus, 503 W. 31st, Lumberton 
Andrews, Mrs. George R. 

3354 Hampton Road Raleigh 

Andrews, Mrs. Leon Polk 

2217 Winterlocken Rd Fayetteville 

Andrews, Mrs. Robert Jackson 

1130 S. Live Oak Parkway Wilmington 

Andrews, Mrs. Vernon Liles Mt. Gilead 

Anthony, Mrs. Luther Leslie, 

1210 Jones St Gastonia 

Anthony, Mrs. William Augustus 

1203 Belvedere Ave Gastonia 



September, 1960 



ROSTER OF MEMBERS 



415 



Antonakos, Mrs. Theodore Danbury 

Arena, Mrs. Jay Morris, 2032 Club Brvd.., Durham 
Arey, Mrs. John Vincent, 89 Caldwell Dr. Concord 
Armistead, Mrs. Drury Branch 

1603 E. 6th St Greenville 

Armstrong, Mrs. Beverly Welier 

1 Armstrong- Drive Charlotte 

Arney, Mrs. William Charles, 

W. Park Dr. ..._ Morganton 

Arnold, Mrs. Jesse Hoyt, Jr. 

709 W. Highland Ave Kinston 

Arnold, Mrs. Ralph A., 911 Urban Ave., ....Durham 
Arrendell, Mrs. Cad Walder, Jr. 

500 Merwick CI. Charlotte 

Arthur, Mrs. Robert 

308 Hinsdale Ave Fayetteville 

Arthur, Mrs. Robert Key, Jr. 

405 Rolling Rd High Pome 

Ashe, Mrs. John Rainey, Jr. 

203 Grandview Dr Concord 

Ashford, Mrs. Charles Hall 

605 Pollock St New Bern 

Atkins, Mrs. Stanley Sisco 

7 N. Dogwood Rd Asheville 

Ausband, Mrs. John Rufus 

817 Shoreland Rd Winston-Salem 

Ausherman, Mrs. Howard Milton 

233 Fenton Place Charlotte 

Austin, Mrs. Frederick DeCosta, Jr. 

605 Colville Rd „ Charlotte 

Averett, Mrs. Leland Stanley, Jr. 

1506 Whitehall High Point 

Avery, Mrs. Edward Stanley 

1824 Meadowbrook Dr Winston-Salem 

Aycock, Mrs. Edwin Burtis 

Longmeadow Rd Greenville 

Aycock, Mrs. James Bernics 

110 Maehill Dr Lenoir 

Aycock, Mi-s. William Glenn 

E. Graham St Mebane 

Ayers, Mrs. James Salisbury, Finch St., ....Clinton 

Bagby, Mrs. Bathurst Browne, Jr. 

17 Highland Rd Asheville 

Baggett, Mrs. Joseph Woodrow 

365 Valley Rd Fayetteville 

Bahnson, Mrs. Edward Reid 

2525 Windsor Rd Winston-Salem 

Bailey, Mrs. Clarence Whitfield 

512 Shady Circle Dr Rocky Mount 

Bailey, Mrs. Joseph Peden Hendersonvilie 

Bailey, Mrs. Mercer H. 

Winslow Acres Elizabeth City 

Bailey, Mrs. Robert Carl, 330 Scenic Dr., Concord 
Baker, Mrs. Barnwell Rhett 

31 Buena Vista Rd Asheville 

Baker, Mrs. Herbert Marvin Faith 

Baker, Mrs. Horace Mitchell, Jr. 

1901 N. Elm St Lumberton 

Baker, Mrs. Horace Mitchell, Sr. 

703 N. Elm St Lumberton 

Baker, Mrs. Larry Duanc 

3116 Gardner Park Dr Gastonia 

Baker, Mrs. Lenox Ditl 

3106 Cornwall Rd., Hope Valley Durham 

Baker, Mrs. Roger D. 

303 Swift Ave Durham 

Baker, Mrs. Thomas Williams 

2029 Queens Rd. Charlotte 

Baldwin, Mrs. William Edwin, Jr. 

Wilmington Rd Whiteville 

Ballenger, Mrs. Claude Newton 

750 Pee Dee Ave Albemarle 

Ballew, Mrs. James Robert 

901 Lake Boone Trail Raleigh 

Balsley, Mrs. Robert Eugene 

825 Crescent Drive Reidsville 

Baluss, Mrs. John William, Jr. 

2315 Westdale Dr Fayetteville 



Bandy, Mrs. William Gaither 

601 N. Laurel St Lincolnton 

Bandy, Mrs. William Henry 

Dogwood Hills Newton 

Barden, Mrs. Graham Arthur, Jr. 

412 Johnson St New Bern 

Barefoot, Mrs. Graham Ballard 

120 Forest Hills Dr Wilmington 

Barefoot, Mrs. Julius J., Jr. 

Morehead Rd New Bern 

Barefoot, Mrs. Sherwood Washington 

3107 Madison Ave Greensboro 

Barefoot, Mrs. William Frederick 

Chadbourn Rd Whiteville 

Barker, Mrs. Christopher Sylvanus 

711 Broad St New Bern 

Barnes, Mrs. Frank Edward, Jr. 

513 Church St Smithfield 

Barnes, Mrs. Henry Eugene, Jr. 

528 First Ave., N. W Hickory 

Barnes, Mrs. James Allen 

2259 Sherwood Dr Winston-Salem 

Barnes, Mrs. M. Russell, Jr. 

128 Bryan PI Jacksonville 

Barnhardt, Mrs. Albert Earl, Box 652, Kannapolis 
Barnhill, Mrs. Otha Allen, Box 505, Elizabethtown 
Barrett, Mrs. John Milton 

805 James St Greenville 

Barrick, Mrs. Harry, Jr. 

914 Lake Boone" Trail Raleigh 

Barrier, Mrs. Henry Webster 

1500 Central Dr Concord 

Barringer, Mrs. Archie Lipe 

Box 278 Mt. Pleasant 

Barringer, Mrs. Phil Lewis, Forest Hills, Monroe 
Barron, Mrs. John Isaac 

508 Riverside Dr _ Morganton 

Barry, Mrs. William, 216 Roberts St., Raeford 

Barry, Mrs. William Francis, Jr. 

1022 Gloria Ave Durham 

Bartels, Mrs. Kenneth Garber 

312 Regal Hendersonvilie 

Bartlett, Mrs. Stephen Russell, Jr. 

208 N. Longmeadow Rd Greenville 

Bass, Mrs. Beaty Lee 

415 S. Ridgecrest Ave Rutherfordton 

Bates, Mrs. Harold Bascom 

1007 Sherwood Dr Burlington 

Batten, Mrs. Hubert Elmore 

301 Fairfield Rd ...Fayetteville 

Batten, Mrs. Woodrow, 402 Church St., Smithfield 
Baylin, Mrs. Georg-e Jay 

2535 Wrightw T ood Ave Durham 

Baynes, Mrs. Ralph H Hurdle Mills 

Beale, Mrs. Seth McPhsrson, Box 508 Elkin 

Beall, Mrs. Lawrence Lincoln 

1850 North Elm St Greensboro 

Bear, Mrs. Sigmond Aaron 

1415 S. Live Oak Parkway Wilmington 

Beavers, Mrs. Charles Lee 

1110 Sunset Dr Greensboro 

Beavers, Mrs. James Wallace 

2206 W. Market St Greensboro 

Beavers, Mrs. William Olive, Routs 1, McLeansville 

Beck, Mrs. J. Montgomery, Route 7, Burlington 

Becknell, Mrs. George Franklin, Jr. 

Forest Hills Forest City 

Beddingfield, Mrs. Edgar Theodore, Jr. 

Stantonsburg 

Belcher, Mrs. Cecil Cullen, 28 Hilltop, ....Asheville 
Belk, Mrs. George Washington 

403 W. 6th Ave Gastonia 

Bell, Mrs. George Erick, Sr. 

1505 W. Nash St Wilson 

Bell, Mrs. Ira Eugene 

508 6th St., N. W Hickory 

Bell, Mrs. Orville Earl 

829 Sycamore St Rocky Mount 



416 



NORTH CAROLINA MEDICAL JOURNAL 



September, 10(50 



Bell, Mrs. Spencer Alexander 

Box 33 Hamptonville 

Bellamy, Mrs. Robert Hartlee 

Greenway Ave Wilmington 

Benbow, Mrs. Edgar Vernon 

1411 Reynolda Rd _ ...Winston-Salem 

Benbow, Mrs. Edward Perry, Jr. 

3809 Fiiendly Road Greensboro 

Bender, Mrs. John Joseph Red Springs 

Bender, Mrs. John Robert 

1166 S. Hawchorne Rd Winston-Salem 

Bennett, Mrs. E;nest Claxton 

Box 295 Elizabethtown 

Bennett, Mrs. Harron Kent Archdale 

Bennett, Mrs. Hugh Hammond, Jr. 

441 Circle Dr Burlington 

Bennett, Mrs. John Northwood 

c/o Wilkes General Hospital .North Wilkesboro 
Bennett, Mrs. Paul, Jr., 109 S. Andrews, Goldsboro 
Bensen, Mrs. Vladimir Basil 

Blue Ridge Road Raleigh 

Benson, Mrs. John Fisher 

710 Gatewood High Point 

Benson, Mrs. Norman Oliver 

203 E. 19th St Lumberton 

Benton, Mrs. George Ruffin, Jr. 

207 S. Pineview Ave Goldsboro 

Benton, Mrs. Wayne Jefferson 

1003 N. Eugene St Greensboro 

Berkeley, Mrs. Alfred Rives, Jr. 

541 Hempstead Place Charlotte 

Berkeley, Mrs. William Thomas, Jr. 

1870 Queens Rd., W Charlotte 

Berry, Mrs. Francis Xavier 

1208 Colonial Ave Greensboro 

Berryhill, Mrs. Walter Reece 

Box 866, Upper Laurel Hill Chapel Hill 

Bertling, Mrs. Marion Henry 

2312 Princess Ann St Greensboro 

Best, Mrs. Deleon Edward 

1504 E. Mulberry St Goldsboro 

Best, Mrs. William Ross 

1510 Sherwood Dr Burlington 

Bethea, Mrs. William Thad Fair Bluff 

Betts, Mrs. Wilmer Conrad 

3422 Leonard St Raleigh 

Biggs, Mrs. Dennis Walter, Jr. 

205 West 22 St Lumberton 

Biggs, Mrs. John Irvin, 2201 Elm St., Lumberton 
Billings, Mrs. Gilbert M., 122 Powe St., Morganton 
Bingham, Mrs. Robert Knox, 105 Hardin St., Boone 

Bitting, Mrs. Numa Duncan, 34 Oak Dr Durham 

Bittinger, Mrs. Charles Lewis 

734 Pinewood Circle Mooresville 

Bittinger, Mrs. Samuel Moffett 

Blue Ridge Rd Black Mountain 

Bivens, Mrs. Edward Shirley 

601 East St Albemarle 

Bizzell, Mrs. James W., Overbrook Drive, Goldsboro 
Bizzell, Mrs. Marcus Edward 

500 E. Walnut St Goldsboro 

Black, Mrs. George William 

1566 Queens Rd., W Charlotte 

Black, Mrs. John Riley, Jr. 

212 Jefferson St Whiteville 

Black, Mrs. Kyle Emerson, Acorn Lane, Salisbury 
Black, Mrs. Paul Adrian Lawrence 

2732 Park Ave Wilmington 

Blackmon, Mrs. Bruce Bernard Buie's Creek 

Blackwelder, Mrs. Verne Hamilton 

323 S. Mulberry St Lenoir 

Blair, Mrs. Andrew B. 

1220 Queens Rd., W Charlotte 

Blair, Mrs. George Walker, Jr. 

460 Parkview Dr Burlington 

Blair, Mrs. James Samuel 

1116 Cumberland Ave Gastonia 

Blair, Mrs. Mott Parks Marshville 



Blake, Mrs. Damon 

645 Kingsbury Circle Winston-Salem 

Blanchard, Mrs. George Caswell 

1701 Brandon Rd Charlotte 

Bland, Mrs. Delmar Earl 

289 Canterbury Trail Winston-Salem 

Bland, Mrs. William Herbert, 401 West Cary 

Blue, Mrs. John Frederick, Brinn Drive, Sanford 
Blue, Mrs. Waylon, 2505 Dalrymple Rd., Sanford 
Boggs, Mrs. Lawrence Kennedy 

2208 Wellesley Ave Charlotte 

Bolin Mrs. Grover Cleveland Jr. 

Crescent Drive Smithfield 

Bolin, Mrs. Lewis Bryant, 111 Will St., ...Mt. Airy 
Bolon Mrs. Charles Gordon 

4733 Wendover Lane Charlotte 

Bolt, Mrs. Conway Anderson, Box 368, Marshville 
Bolus, Mrs. Michael, 2220 Wheeler Rd., ...Raleigh 
Bond, Mrs. Edward Griffith, 

102 Pembroke Circle Edenton 

Bond, Mrs. John Pennington 

1806 Fairfield Dr Gastonia 

Bond Mrs. Vernard Franklin Jr. 

340 Buckingham Rd Winston-Salem 

Bonner Mrs. John Bryan Havens 

1100 Riverside Ave Elizabeth City 

Bonner, Mrs. Merle Dumont 

203 Kimberly Dr Greensboro 

Bonner Mrs. Octavius Blanchard 

408 Edgedale Dr High Point 

Boone, Mrs. John W., Jr. 

826 Monroe St Roanoke Rapids 

Boone, Mrs. William Waldo 

1001 Gloria Ave Durham 

Borden, Mrs. Richard Winstead 

1600 E. Elm St Goldsboro 

Boren Mrs. Richard Benjamin III 

813 N. Bridge St Elkin 

Bos, Mrs. John Fremont 

1574 Clayton Dr Charlotte 

Bostic Mrs. William Chivous, Jr. 

535 E. Main St Forest City 

Bourgeois, Mrs. Michael 

1017 Norwood Ave Durham 

Bower, Mrs. Joseph Shelton 

1100 N. Queen St Kinston 

Bowles, Mrs. Francis Norman 

1400 Shepherd St Durham 

Bowman, Mrs. Earl L. 

1101 N. Walnut St Lumberton 

Boyce, Mrs. Oren Douglas, Boyceleyn Rd., Gastonia 
Boyce, Mrs. William Henry 

939 N. Stratford Rd Winston-Salem 

Boyd, Mrs. Basil Manley, Jr. 

1816 Maryland Ave Charlotte 

Boyes, Mrs. James Gordon, Jr. 

1163 Country Club Rd. Wilmington 

Boyette, Mrs. Ben Robert, Jr. 

1508 E. Palm St Goldsboro 

Brabson, Mrs. John Anderson 

323 Hempstead PI Charlotte 

Bradford, Mrs. George Edwin 

444 Roslyn Rd Winston-Salem 

Bradford, Mrs. Williamson Ziegler 

310 Colville Rd Charlotte 

Bradish, Mrs. Robert F. 

1712 Raeford Rd Fayetteville 

Bradley, Mrs. Harold John 

105 W. Brentwood Greensboro 

Bradley, Mrs. John David, 5 Ravenna Dr., Asheville 
Bradshaw, Mrs. Howard Holt 

2837 Reynolds Rd Winston-Salem 

Bradsher, Mrs. Arthur Brown 

421 Carolina Circle Durham 

Bradsher, Mrs. James Donald, Box 168 . .. Roxboro 
Brady, Mrs. Charles Eldon, Carthage Rd., Robbins 
Brady, Mrs. Walter Morris Morehead City 



September, 1960 



ROSTER OF MEMBERS 



417 



Branaman, Mrs. Guy Hewitt, Jr. 

915 Williamson Dr Raleigh 

Brandon, Mrs. Henry Allen Yadkinville 

Brantley, Mrs. Coleman 

1803 Wright Ave Greensboro 

Brantley, Mrs. Julian Chisolm, Jr. 

1507 Lafayette Ave Rocky Mount 

Brantley. Mrs. Julian Thweatt 

1500 Independence Rd Greensboro 

Bream, Mrs. Charles Anthony 

211 McCauley St Chapel Hill 

Breeden, Mrs. William Henry 

1524 Morganton Rd Fayetteville 

Brenizer, Mrs. Addison Gorgas, Jr. 

1301 Providence Rd Charlotte 

Bressler, Mrs. Bernard, 2700 Circle Dr., Durham 

Brewer, Mrs. James Street Roseboro 

Brian, Mrs. Earl Winfrey 

2111 White Oak Rd Raleigh 

Brice, Mrs. George Wilson, Jr. 

3961 Arbor Way Charlotte 

Bridger, Mrs. Dewey Herbert Bladenboro 

Bridges, Mrs. Dwight Thomas Lattimore 

Briggs, Mrs. Henry Harrison, Jr. 

323 Vanderbilt Rd Asheville 

Brigman, Mrs. Paul Hamer 

1005 College Dr High Point 

Brinkhous, Mrs. Kenneth Merle 

Box 1020 Chapel Hill 

Brinn, Mrs. Thomas Preston 

105 Front St Hertford 

Bristow, Mrs. Charles Oliver 

504 Fayetteville Rd Rockingham 

Britt, Mrs. Tilman Carlisle, Jr. 

130 Rawley Ave Mt. Airy 

Britt, Mrs. Walter S. 

Veterans Hospital Fayetteville 

Brittain, Mrs. Lowell Ellis Huntersville 

Brockmann, Mrs. Harry Lyndon 

912 Fairway Dr High Point 

Brooks, Mrs. Ernest Bruce 

2853 Bitting Rd Winston-Salem 

Brooks, Mrs. Frederick Philips 

Greenville Blvd Greenville 

Brooks, Mrs. Martin Luther, Box 141 ...Pembroke 
Brooks, Mrs. Ralph Elbert 

1303 Rainey St Burlington 

Brooks, Mrs. William Lester, Jr. 

2110 Queens Rd., W Charlotte 

Broughton, Mrs. Arthur Calvin, Jr. 

3008 Eton Rd Raleigh 

Broun, Mrs. Matthew Singleton 

606 Roanoke Ave Roanoke Rapids 

Brouse, Mrs. Ivan Edwin 

Masonboro Sound Wilmington 

Brown, Mrs. Alan Reid .Waynesvilie 

Brown, Mrs. Charles William 

227 Fenton Place Charlotte 

Brown, Mrs. Frank Reid 

1103 Country Club Dr Greensboro 

Brown, Mrs. George Wallace, Jr Waynesvilie 

Brown, Mrs. Gerald Joseph Westfield 

Brown, Mrs. Ivan W., Jr., 1709 Vista Dr., Durham 
Brown, Mrs. James Walter, Jr. 

33 Grandview Dr Concord 

Brown, Mrs. Kermit English 

Chunns Cove Rd Asheville 

Brown, Mrs. Landis G Southport 

Brown, Mrs. William Thomas 

1308 Pine St Laurinburg 

Bruce, Mrs. James Crawford 

2902 Dublin Greensboro 

Brunson, Mrs. Edward Porcher 

804 Pee Dee Ave Albemarle 

Bruton, Mrs. Charles Wilson Troy 

Bryan, Mrs. Thomas R., Jr. 

Finley Park _ North Wilkesboro 



Buffaloe, Mrs. William Joseph 

906 Tate Dr Raleigh 

Bugg, Mrs. Charles Paulett 

320 W. Drewry Lane _...Raleigh 

Bugg, Mrs. Everett I., Jr. 

1544 Hermitage Ct Durham 

Buie, Mrs. Roderick Mark, Sr. 

119 Kensington Rd Greensboro 

Buie, Mrs. Roderick Mark, Jr. 

108 Elgin Place Greensboro 

Bullock, Mrs. Duncan Douglas, Sr Rowland 

Bumgarner, Mrs. John Reed 

2101 Mimosa Dr Greensboro 

Bunce, Mrs. Paul Leslie, Route 3 Chapel Hill 

Bundy, Mrs. James Bizzell 

433 McRae Dr Fayetteville 

Bundy, Mrs. William Lumsden 

Finley Park North Wilkesboro 

Bunn, Mrs. David Glenn, Maple St Whiteville 

Bunn, Mrs. Richard Wilmot 

411 Plymouth Ave Winston-Salem 

Burleson, Mrs. Robert Joe 

36 Elk Mountain Scenic Hwy Asheville 

Burnett, Mrs. Charles Hoyt 

Laurel Hill Road Chapel Hill 

Burnett, Mrs. Thomas J. M. 

4756 Stafford Circle Charlotte 

Burnette, Mrs. Harvey Loraine, Jr Morven 

Burns, Mrs. Joseph Eugene 

41 Ingleside Dr Concord 

Burns, Mrs. Stanley Sherman, Jr. 

2312 Pembroke Ave Charlotte 

Burt, Mrs. Richard Lafayette 

2801 Robin Hood Rd Winston-Salem 

Burwell, Mrs. John Cole, Jr. 

110 Homewood Dr Greensboro 

Busby, Mrs. George Francis 

Confederate Ave Salisbury 

Busby, Mrs. Julian, 401 Idlewood Dr., Kannapolis 
Busby, Mrs. Trent, 530 Confederate Ave., Salisbury 
Busse, Mrs. Ewald W. 

1423 Woodburn Rd Durham 

Butler, Mrs. Radford Norman 

810 Clovelly Rd Winston-Salem 

Butler, Mrs. Raymond Kenneth Waynesvilie 

Byerlv, Mrs. Frederick Lee 

2000 Robin Hood Rd Winston-Salem 

Byerly, Mrs. James Hampton, 620 Carr St., Sanford 
Byerly, Mrs. Wesley Grimes, Jr. 

546 Sixth St., N. W Hickory 

Byerly, Mrs. Wesley Grimes, Sr. 

211 Highland Ave Lenoir 

Byrd, Mrs. Charles William 

409 S. Orange Ave Dunn 

Byrd, Mrs. William Carey 

State Hospital Morganton 

Byrnes, Mrs. Thomas Henderson 

919 Mt. Vernon Ave Charlotte 

Byrum, Mrs. Clifford Conwell 

2616 Wells Ave Raleigh 

Caddell, Mrs. H. Morris 

Pinehurst-Pinebluff Rd Aberdeen 

Cain, Mrs. Frank Coral, Jr., Pinola Ave., Gastonia 
Calder, Mrs. Duncan Graham, Jr. 

42 N. Union St Concord 

Caldwell, Mrs. Eston Robert, Jr. 

116 N. Race St Statesville 

Caldwell, Mrs. Jesse Burgoyne 

1307 Park Lane Gastonia 

Caldwell, Mrs. Lawrence McClure 

406 S. College Ave Newton 

Caldwell, Mrs. Robert M. 

224 S. Main St Mt. Airy 

Caldwell, Mrs. Robert Sims 

520 2nd St., N. W Hickory 

Callaway, Mrs. Jasper Lamar 

828 Anderson St Durham 



IIS 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



Camblos, Mrs. Joshua Fry Bullitt 

17 Forest Rd Asheville 

Cameron, Mrs. George 

307 Westview Drive Fayetteville 

Cameron, Mrs. Joseph Harold 

1217 Crescent Ave Gastonia 

Camp, Mi . Edward Hays Waynesville 

Campbell, I " s. Frank Highsmith 

320 Valley Rd Fayetteville 

Campbell, Mrs. James Melvin 

2115 Yost Avj Salisbury 

Campbell, Mrs. 1 aul Curtis, Jr. 

2215 Meadow \.ood Rd - Fayetteville 

Carpenter, Mrs. Coy Cornelius 

Route 1, Bethabara Road Winston-Salem 

Carpenter, Mrs. Harry M. 

713 Austin Lane Winston-Salem 

Carr, Mrs. Chalmers Rankin 

1715 Queens Rd Charlotte 

Carr, Mrs. Edward Sleight 

3210 Forsyth Greensboro 

Carrington, Mrs. George Lunsford 

139 Piedmont Way Burlington 

Carroll, Mrs. Charles Fisher 

263 Grandview Dr Concord 

Carroll, Mrs. Fountain Williams Hookerton 

Carroll, Mrs. Francis Murray Chadbourn 

Carter, Mrs. Francis Bayard 

2111 Myrtle Dr Durham 

Carter, Mrs. Needham Battle 

226 Timberlane Road Rocky Mount 

Carter, Mrs. Warren Dallas Wadesboro 

Carver, Mrs. Gordon Malone, Jr. 

2214 Cranford Rd Durham 

Casstevens, Mrs. John Claude 

130 Pine Valley CI Winston-Salem 

Gates, Mrs. Banks Raleigh, Jr. 

2833 Sunset Dr Charlotte 

Cathell, Mrs. James L., State Hospital Butner 

Caughran, Mrs. John H. 

4400 Halsteaci Dr Charlotte 

Causey, Mrs. Andrew Jackson 

210 "Valley Stream Rd. Statesville 

Caveness, Mrs. Zebulon Marvin 

1804 Hillsboro St Raleigh 

Caviness, Mrs. Verne Strudwick 

913 Vance St Raleigh 

Caver, Mrs. David 

2754 Robin Hood Rd Winston-Salem 

Cecil, Mrs. Richard C. 

2314 Gunston Court Fayetteville 

Cekada, Mrs. Emil Bogomir, 915 Green St., Durham 

Cernugel, Mrs. Albert Peter - Chadbourn 

Chambers, Mrs. Robert Edward 

313 Ruby Lane Gastonia 

Chamblee, Mrs. John Sigma 

607 E. Church St Nashville 

Chandler, Mrs. Edgar Ted 

28 7th Ave., N. E Hickory 

Chandler, Mrs. Weldon Porter 

Box 458 Weaverville 

Chapin, Mrs. John Harmon Benson 

Chapman, Mrs. Charles Granger 

6134 Deveron Dr Charlotte 

Chapman, Mrs. Edwin James 

264 Lakeshore Dr Asheville 

Chapman, Mrs. Jesse Pugh, Jr. 

81 Sheridan Rd Asheville 

Charlton, Mrs. John David 

911 Magnolia St Greensboro 

Chastain, Mrs. Loren Lee Cherryville 

Cheek, Mrs. John Merritt, Jr. 

1025 Sycamore St Durham 

Cheek, Mrs. Kenneth Maurice 

402 E. Farriss .High Point 

Cherny, Mrs. Walter B. 

1510 Carolina Ave Durham 



Chesson, Mrs. Arthur Saunders, Jr. 

310 S. Andrews Ave Goldsboro 

Chiles, Mrs. Noah Hampton 

1031 Wellington High Point 

Citron, Mrs. David Sanford 

2100 Cumberland Ave Charlotte 

Clapp, Mrs. Hubert Lee 

Eastwood Ave Swannanoa 

Clark, Mrs. DeWitt Duncan, Lox 72"^, Clarkton 

Clark, Mrs. Douglas Hendon 

207 W. 26th St Lumberton 

Clark, Mrs. Harold Stevens 

9 Lakewood Dr. Asheville 

Clark, Mrs. Henrv Toole, Jr., Box 1370, Chapel Hill 
Clark, Mrs. Milton Stephen 

1808 E. Walnut Goldsboro 

Clark, Mrs. Patrick Francis 

208 Cumberland Asheville 

Clarke, Mrs. Len Gordon 

606 Fieldcrest Rd. Draper 

Clarke, Mrs. William Lowe, Jr. 

401 7th Ave. PI., N. W Hickory 

Clary, Mrs. William Thomas 

507 Chancery PI Greensboro 

Clay, Mrs. Thomas Barger, Jr. 

300 N. Third Ave Mayodan 

Clayton, Mrs. Eugene Cook 

17 St. Charles PI Asheville 

Cleaver, Mrs. H. DeHaven 

213 Cornwallis Rd Durham 

Clinton, Mrs. Roland Smith 

1305 Fairfield Dr Gastonia 

Clippinger, Mrs. Frank W. 

2511 Pickett Rd Durham 

Cloninger, Mrs. Charles Edgar Conover 

Cloninger, Mrs. Giles Lathern 

301 Dogwood Lane Hamlet 

Cloninger, Mrs. Kenneth Lee 

Westlake Hills Newton 

Cloninger, Mrs. Rowell Connor 

Westfield Rd Shelby 

Clutts, Mrs. George Robert 

227 N. Park Dr Greensboro 

Cobey, Mrs. William Gray 

527 Clement Ave Charlotte 

Cochcroft, Mrs. Roy Leicester 

217 W. Washington Ave Bessemer City 

Cochran, Mrs. John L., Jr. 

413 N. Elm St Asheboro 

Cochrane, Mrs. Fred Richard, Jr. 

1614 Maryland Ave Charlotte 

Codington, Mrs. John Bonnell 

2715 Columbia Ave Wilmington 

Coffee, Mrs. Archie Thomas, Jr. 

2717 Chilton PI Charlotte 

Coffman, Mrs. Selby, Longmeadow Rd. .Greenville 
Cogdell, Mrs. David Melvin 

2827 Skye Dr Fayetteville 

Coggeshall, Mrs. Allen Bancroft 

109 Beverly PI Greensboro 

Cohen, Mrs. Sanford Irwin 

1527 Woodburn Rd Durham 

Coker, Mrs. Robert Ervin, Jr. 

810 Christopher Rd Chapel Hill 

Cole, Mrs. Herman Alfonse 

211 E. Blanche Clayton 

Cole, Mrs. Robert Hickman 

1537 Coventry Rd Charlotte 

Cole, Mrs. Walter Francis 

201 E. Avondale Greensboro 

Coleman, Mrs. Lester Livingston 

428 Sixth St., N. W Hickory 

Colev, Mrs. Ehvood Brogden 

602 W. 31st St Lumberton 

Collett. Mrs. James Rountree 

W. U^ion St Morganton 

Collins, Mrs. Wan-en James, 713 Ridgeview, Shelby 



September, 1960 



ROSTER OF MEMBERS 



419 



Combs, Mrs. Fielding 

438 Carolina Circle Winston-Salem 

Combs, Mrs. Joseph John 

2125 White Oak Rd Raleigh 

Compton, Mrs. John Wallace 

608 S. Oleander Ave Goldsboro 

Cook, Mrs. Henry Lilly, Jr. 

Irving Park Manor Greensboro 

Cook, Mrs. Joseph Lindsay 

Nutbush Rd Greensboro 

Cook, Mrs. William Eugene 

115 S. Churchill Dr Fayetteville 

Cooke, Mrs. Grady Carlyle 

Bonham Heights Morehead City 

Cooke, Mrs. Hershall Marcus 

Route 1, Box 227 Boone 

Cooke, Mrs. Quinton Edwin 

212 E. High St Murfreesboro 

Cooke, Mrs. Ralph M., E. Main Sc Eikin 

Cooley, Mrs. Samuel Studdiford 

221 New Bern Ave Black Mountain 

Cooper, Mrs. Albert Derwin 

1006 Dacian Ave Durham 

Cooper, Mrs. Frank Benton 

1129 Emerald St Salisbsury 

Cooper, Mrs. George Marion 

411 Marlowe Road Raleigh 

Copnedge, Mrs. Thomas Oliver, Jr. 

112 Cedar Lane, Route 2 Charlotte 

Coppridge, Mrs. James Alston 

2020 Wilson St Durham 

Cop;>ridge, Mrs. William Maurice 

1024 W. Forest Hills Blvd Durham 

Corbett, Mrs. Clarence Lee 

W. Cumberland St Dunn 

Corbett, Mrs. James Patrick Swansboro 

C-orbin, Mrs. George Wesley, Jr Rolesville 

Cordell, Mrs. Alfred Robert 

963 Kenleigh Circle Winston-Salem 

Cornwell, Mrs. Abner Milton 

825 S. Aspen St Lincolnton 

Corpening, Mrs. Joseph Durham 

228 Rutherford St Salisbury 

Corpening, Mrs. Oscar J Granite Falls 

Corpening, Mrs. William Nye Granite Falls 

Correll, Mrs. Earl Eugene 

1603 Eastwood Drive Kannapolis 

Cosgrove, Mrs. Kenneth Edward 

306 Laurel Dr .Hendersonville 

Costner, Mrs. Walter Vance 

501 N. Cedar St Lincolnton 

Coughlin, Mrs. Joyce Desmond 

150 Cherokee Rd Asheville 

Council, Mrs. Albert Barbee 

Von Ruck St Spray 

Couturier, Mrs. Maurice George, Sr Reidsville 

Covington, Mrs. Furman Payne 

216 Forsyth St. Thomasville 

Covington, Mrs. James Madison, Sr Wadesboro 

Covington, Mrs. James Madison, Jr. 

Morven Road — ~ Wadesboro 

Covington, Mrs. John Malloy Clayton 

324 Jackson St Roanoke Rapids 

Covington, Mrs. Mai-tin Cade 

2107 Woodland Ave Sanford 

Cox, Mrs. Alexander McNeil 

325 Market St Madison 

Cox, Mrs. Samuel Clements 

8 E. Bayshore Blvd Jacksonville 

Cox, Mrs. William Foscue 

2722 Reynolds Rd Winston-Salem 

Cozart, Mrs. Benjamin Franklin 

Box 1289 Reidsville 

Cozart, Mrs. Wiley Holt 

Box 327 -Fuquav Springs 

Cozart, Mrs. Wiley S. 

333 S. Main Fuquay Springs 



Craddock, Mrs. John Goodwin 

1501 Anderson St Wilson 

Craig, Mrs. Robert Lawrence 

382 Montford Ave Asheville 

Craig, Mrs. William Kenneth Enfield 

Crandell, Mrs. Daniel LeRoy 

755 Pine Valley Rd Winston-Salem 

Crane, Mrs. George Levering 

2028 Pershing St Durham 

Crane, Mrs. George William, Jr. 

2618 Augusta Dr Durham 

Craven, Mrs. Frederick Thorns 

29 Ravine Ave Concord 

Crawford, Mr?. Robert Hope 

216 S. Ridgecrest Ave Rutherfordton 

Crawford, Mrs. Robert Orr, Jr. 

P. O. Eox 483 Claremont 

Crawford, Mrs. William Jennings 

1500 E. Ash St Goldsboro 

Crawley, Mis. Sam Jones, Jr Boiling Springs 

Crer.'.ick. .lis. Robert Nowell 

1200 Andsrson St Durham 

Creech. Mrs. Lemuel Underwood 

220 Edgedale Dr High Point 

Creed, Mrs. George Otis, Johns Rd Laurinburg 

Cre:cenzo, Mrs. Victor M. 

Belmcnt Drive Reidsville 

Crisp, Mrs. Sellers Mark 

1201 E. 5th St ..-_- Greenville 

Crissman, Mrs. Clinton S., Chapel 1-j.ill Rd., Graham 
Cronland, Mrs. Murphy Allen 

226 W. Pine Lincolnton 

Croom, Mrs. Arthur Bascom 

1102 Greenwav Dr High Point 

Croom, Mrs. Robert DeVane, Jr Maxton 

Crosby, Mrs. James Foster 

5015 Park Road Charlotte 

Crosby, Mrs. Lewis Pearce Reidsville 

Cross, Mrs. Almon Rufus 

414 Hillcrest Dr .High Point 

Cross, Mrs. Robert Vandervoort 

920 Fairway Dr High Point 

Crouch, Mrs. Auley McRae, Sr. 

520 Dock St Wilmington 

Crouch, Mrs. Auley McRae, Jr. 

1419 S. Live Oak Parkway Wilmington 

Crouch, Mrs. Walter Lee 

1211 S. Live Oak Parkway Wilmington 

Crow, Mrs. Samuel Leslie 

12 N. Kensington Rd. Asheville 

Crowell, Mrs. James Allen 

1529 E. Morehead St Charlotte 

Crowell, Mrs. Lester Avant, Jr. 

413 S. Aspen St Lincolnton 

Crumpler, Mrs. James Fulton 

1409 West Haven Blvd Rocky Mount 

Crumpler, Mrs. Paul 

401 Lafayette St Clinton 

Crumpler, Mrs. Warren Harding 

N. Johnson St Mt. Olive 

Crutchfield, Mrs. Andrew Jackson 

300 Plymouth Ave Winston-Salem 

Cubberlev, Mrs. Charles Lamb, Jr. 

505 Lafayette Dr Wilson 

Cuibreth, Mrs. George Gordon 

2228 Queens Rd., E Charlotte 

Cumen, Mrs. Edward C, Jr. 

322 W. University Dr Chapel Hill 

Currie, Mrs. Daniel Smith, Jr. 

302 Churchill Dr Fayetteville 

Currie, Mrs. Daniel Smith, Sr Parkton 

Currv, Mrs. Clayton Smith 

2701 Bucknell Ave Charlotte 

Curtis, Mrs. Thomas E. 

Sherwood Forest Chapel Hill 

Cutchin, Mrs. Joseph Henry, Sr. 

Box 202 Whitakers 

Cutchin, Mrs. Joseph Henry, Jr Sherrill's Ford 



420 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Cutri, Mrs. Joseph John 

Graylyn Court Winston-Salem 

Dale, Mrs. Frederick Payne 

503 Rhodes Ave Kinston 

Dalton, Mrs. Horace Milton 

1705 Cambridge Dr Kinston 

Daly, Mrs. Rosvvell Bernard Waxhaw 

Dameron, Mrs. Thomas Barker, Jr. 

2710 E. Rothgeb Dr. .. Raleigh 

Daniel, Mrs. Crowell Turner, Jr. 

330 Pinecrest Dr Fayetteville 

Daniel, Mrs. Thomas Brantley 

3231 Sussex Rd Raleigh 

Daniel, Mrs. Thomas Manning 

524 S. Fourth St Smithfield 

Daniel, Mrs. Walter Eugene 

2115 Roswell Ave Charlotte 

Daniels, Mrs. Robert Edward 

23 Vance Crescent West Asheville 

Darden, Mrs. James Lee, Jr. 

1000 Pembroke Ave Ahoskie 

Daughtridge, Mrs. Arthur Lee 

501 Shady Circle Dr Rocky Mount 

Daughtridge, Mrs. Griffin Caswell 

526 Marigold St Rocky Mount 

Davant, Mrs. Charles, Chestnut Dr., Blowing Rock 
Davenport, Mrs. Carlton Alderman 

207 Front St Hertford 

Davenport, Mrs. Clifton Lake Waccamaw 

Davidson, Mrs. Alan, Morehead Rd New Bern 

Davidson, Mrs. James Hubert 

2200 Sprunt St Durham 

Davis, Mrs. Courtland Harwell, Jr. 

841 Westover Ave Winston-Salem 

Davis, Mrs. David A., Kings Mill Rd., Chapel Hill 

Davis, Mrs. Jack Beason Waynesville 

Davis, Mrs. James Evans, 7 Beverly Dr., Durham 

Davis, Mrs. James Matheson Wadesboro 

Davis, Mrs. John Woodrow 

Route 5, Box 509 Hickory 

Davis, Mrs. Joseph Franklin 

Box 6291 Summit Station Greensboro 

Davis, Mrs. Junius Weeks, Jr. 

Trent Shores New Bern 

Davis, Mrs. Philip Bibb 

807 Florham Ave High Point 

Davis, Mrs. Richard Boyd 

122 S. Green Greensboro 

Davis, Mrs. Rufus Jackson, Lakewood, Cramerton 
Davis, Mrs. Wayne Edward 

321 Avalon Road ..Winston-Salem 

Davis, Mrs. William Hersey, Jr. 

723 N. Stratford Rd Winston-Salem 

Davison, Mrs. Wilburt Cornell 

3004 Norwich Way Durham 

Dawson, Mrs. James Nelson Acme-Delco 

Deaton, Mrs. Paul McNeely 

581 Greenway Dr Statesville 

Deaton, Mrs. William Ralph, Jr. 

101 Elgin Place Greensboro 

DeCamp, Mrs. Allen Ledyard 

1830 Cassamia PI Charlotte 

Deeds, Mrs. Charles Ross 

Haywood Rd Hendersonville 

DeWolfe, Mrs. Phillip William, 

Box 106 Leaksville 

Dick, Mrs. Frederick William 

354 Bost St Statesville 

Dick, Mrs. Macdonald 

3005 Norwich, Hope Valley Durham 

Dickeison, Mrs. Andi-ew Jackson Waynesville 

Dickie, Mrs. James William 

3003 Wayne Dr Wilmington 

Dickson, Mrs. Brice Templeton, Jr. 

1436 Fern Forest Drive Gastonia 

Dickson, Mrs. Malcolm Shields 

1903 Woodland Ave Burlington 



Dillard, Mrs. Sam Booker 

1309 Biltmore Dr Charlotte 

Dixon, Mrs. George Grady 

503 Snow Hill St Avden 

Dixon, Mrs. Philip Lafayette, Jr. 

1 Bayshore Blvd., E Jacksonville 

Dobson, Mrs. Richard L. 

14 Brandon Rd. Chapel Hill 

Doffermyre, Mrs. Luther Randolph 

W. Harnett St Dunn 

Donald, Mrs. William Blan.on, Jr. 

603 Rockspring Rd .High Point 

Donner, Mrs. Paul Gartrell 

2201 Old Sardis Rd ..Charlotte 

Dorenbusch, Mrs. Alfred A. 

2734 Hampton Ave Charlotte 

Dorman, Mrs. Bruce Hugh 

Greenville Sound Wilmington 

Dorsett, Mrs. John Dewev 

143 Hamilton Rd .. Chapel Hill 

Douglas, Mrs. John Munroe 

400 Fferneliff Charlotte 

Dovenmuehle, Mrs. Robert Henry 

3527 Hamstead Court Durham 

Downs, Mrs. Kenneth Ray 

4112 Barmettler Dr Charlotte 

Downs, Mrs. Posey Edgar, Jr. 

101 Placid Place Charlotte 

Doyle, Mrs. Owen William 

906 Dover Rd Greensboro 

Drake, Mrs. Benjamin Michael 

1310 Jackson Rd Gastonia 

Drake, Mrs. David Ewing 

2616 Bennington Rd Fayetteville 

Drummond, Mrs. Charles Stitl 

2928 Windsor Rd Winston-Salem 

Duckett, Mrs. Charles Howard Canton 

Duckett, Mrs. Virgil Howard Canton 

Dudley, Mrs. Council C, Jr Jonesville 

Dugger, Mrs. Gordon S. 

UNC Medical School Chapel Hill 

Dula, Mrs. Frederick Mast 

214 Hibriten St Lenoir 

Dunn, Mrs. Richard Barry 

1014 N. Elm St Greensboro 

Dunning, Mrs. Everett Jackson 

2501 Danbury St Charlotte 

Durham, Mrs. Carey Winston 

209 W. Ridgeway Dr Greensboro 

Dyer, Mrs. David Patterson Waynesville 

Eagle, Mrs. James Carr, 418 Carolina Ave., Spencer 
Eagle, Mrs. Watt Weems 

804 Anderson St Durham 

Eagles, Mrs. Charles Sidney Saratoga 

Early, Mrs. Ira Gordon 

2510 Bitting Rd Winston-Salem 

Easom, Mrs. Herman Franklin 

508 Mt. Vernon Dr Wilson 

Eastwood, Mrs. Frederick Thomas 

2708 Lakeview Dr Raleigh 

Eaves, Mrs. Rupert Spencer 

611 N. Washington Rutherfordton 

Eckbert, Mrs. William Fox, Southwood ...Gastonia 

Eckerson, Mrs. Charles Troy 

Eddinger, Mrs. Charles Frederick, Box 45, Spencer 
Eddins, Mrs. George Edgar, Jr. 

Norwood Rd Albemarle 

Edgerton, Mrs. Glenn Soulders 

325 Cherokee PI Charlotte 

Edwards, Mrs. Charles Daniel 

418 E. 12th St Washington 

Edwards, Mrs. Vertie D Stokesdale 

Eg-erton, Mrs. Courtney David 

2528 York Rd Raleigh 

Elesha, Mrs. William 

3040 Briarcliffe Rd Winston-Salem 

Elfmon, Mrs. Samuel Leon 

117 Stedman St Fayetteville 



September, 1960 



ROSTER OF MEMBERS 



421 



Ellington, Mrs. Amzi Jefferson, Jr. 

419 Fountain Place Burlington 

Elliott, Mrs. Avon Hall 

607 Colonial Drive Wilmington 

Elliott, Mrs. John Palmer, Greenway Drive, Spray 
Elliott, Mrs. Joseph Alexander, Sr. 

2700 Sherwood Ave Charlotte 

Elliott, Mrs. Joseph Alexander, Jr. 

2224 Sanford Lane Charlotte 

Elliott, Mrs. William McBrayer 

West View Forest City 

Epple, Mrs. Kenneth H. 

1518 Liberty Drive .Greensboro 

Erb, Mrs. Norris Scribner, 8 Oak Rd. ...Salisbury 
Erdman, Mrs. Lawrence Huntington 

P. 0. Box 283 Bridgeton 

Ernst, Mrs. Henry Edwin 

97 Ingleside Dr Concord 

Ervin, Mrs. John Witherspoon 

State Hospital Morganton 

Erwin, Mrs. Evan Alexander, Jr. 

S. Main Laurinburg 

Espey, Mrs. Dan, Jr. 

454 5th St., S. E Hickory 

Estes, Mrs. Edward Harvey, Jr. 

3542 Hamstead Court Durham 

Etherington, Mrs. John Lawrence 

1703 Evergreen Ave Goldsboro 

Fagan, Mrs. Harry, Jr. 

2508 Oxford Rd Raleigh 

Faison, Mrs. Elias Sampson 

1825 Providence Rd. Charlotte 

Fales, Mrs. Robert Martin 

153 Renovah Circle Wilmington 

Falls, Mrs. Fred, 855 W. Marion St Shelby 

Falvo ,Mrs. Samuel Catanzaro 

716 Maybank Drive Hendersonville 

Farley, Mrs. William Winfree 

2625 Dover Rd Raleigh 

Farmei - , Mrs. Thomas Wholsen 

Mason Farm Rd Chapel Hill 

Farmer, Mrs. William Anderson 

2841 Skye Dr Fayetteville 

Farmer, Mrs. William Dempsey 

1011 Country Club Dr Greensboro 

Farmer, Mrs. Woodard Eason 

27 Park Road Asheville 

Faulk, Mrs. James Grady 

1208 E. Franklin Monroe 

Feezor, Mrs. Charles Noel 

6 Pine Tree Rd Salisbury 

Feldman, Mrs. Leon Henry 

6 N. Kensington Rd Asheville 

Felton, Mrs. Robert Lee, Jr., Box 176, Carthage 
Felts, Mrs. John Harvey, Jr. 

245 New Drive Winston-Salem 

Fender, Mrs. James Earle Waynesville 

Ferguson, Mrs. George Burton 

3938 Dover Rd., Hope Valley Durham 

Ferrell, Mrs. John Atkinson 

Apt. 8-B, Carolina Hotel Raleigh 

Fesperman, Mrs. Joseph Claude 

West College St Stanley 

Fetter, Mrs. Bernard Frank 

Summerset Drive Durham 

Feuer, Mrs. Abe Lawrence 

1006 Fairfield Dr Gastonia 

Fewell, Mrs. Richard Alexander 

506 Hillcrest Rd Burlington 

Ficklin, Mrs. Conway 

908 Live Oak Parkway ..Wilmington 

Field, Mrs. Bob Lewis, Box 557 Salisbury 

Fields, Mrs. Leonard Earl 

Box 788, Hidden Hills . Chapel Hill 

Fike, Mrs. Ralph Llewellyn 

901 Raleigh Rd Wilson 

Fincher, Mrs. Robert Charles, Jr. 

107 Spencer St High Point 



Finley, Mrs. Charles Francis 

2323 Morganton Rd Fayetteville 

Fish, Mrs. Harry Gustav, Jr. 

1116 Long Ave Rocky Mount 

Fisher, Mrs. George Walton, Jr. 

2612 Edgewater Dr Fayetteville 

Fitz, Mrs. Thomas Edmunds 

423 10th St. Dr Hickory 

Fitzgerald, Mrs. Charles Edmund 

415 E. Wilson St Farmville 

Fitzgerald, Mrs. John Dean 

210 Crestwood Dr Roxboro 

Fitzgerald, Mrs. John Hill, Jr. 

217 Buff St Lincolnton 

Fitzgerald, Mrs. Robert Greeson, Jr. 

Box 256 Roxboro 

Fleetwood, Mrs. Joseph Anderton, Jr Conway 

Fleetwood, Mrs. Joseph Anderton, Sr Conway 

Fleishman, Mrs. Malcolm 

130 Herndon St Fayetteville 

Fleming, Mrs. Lawrence Edwin 

1116 Providence Rd Charlotte 

Fleming, Mrs. Major Ivy 

104 S. Franklin St Rocky Mount 

Fleming, Mrs. Ralph Gibson 

23 Beverly Dr Durham 

Fleming, Mrs. Samuel Wallace Elm City 

Flippin, Mrs. James Meigs Pilot Mountain 

Flowe, Mrs. Benjamin Hugh, 804 Wilmar, Concord 
Floyd, Mrs. Anderson Gayle 

N. Thompson St Whiteville 

Floyd, Mrs. Hal Stanfield 

Lake View Rd Fairmont 

Floyd, Mrs. Walter, 2011 Woodrow St Durham 

Floyd, Mrs. William Russell 

Mt. Pleasant Highway Concord 

Flythe, Mrs. William Henry 

809 Hillcrest Dr High Point 

Fogleman, Mrs. Ross Lee, Jr. 

904 W. Highland Ave Kinston 

Folio, Mrs. Paige Bill, 1709 Efland Dr., Greensboro 
Fondren, Mrs. Frank 

302 Jackson St Roanoke Rapids 

Forbes, Mrs. Gus Evans, Park Circle, Laurinburg 
Forbes, Mrs. Thomas Earl 

Country Club Drive Reidsville 

Forbus, Mrs. Wiley Davis, 3309 Devon Rd., Durham 
Forrest, Mrs. William W. 

1001 Montpelier Dr Greensboro 

Forsyth, Mrs. Harry Francis 

434 Westview Dr Winston-Salem 

Fortescue, Mrs. William Nicholas 

Kanuga Rd Hendersonville 

Fortney, Mrs. Austin Powell Jamestown 

Fortune, Mrs. Benjamin Fletcher 

906 Cornwallis Dr Greensboro 

Foster, Mrs. John W. 

294 W. End Blvd. Winston-Salem 

Foster, Mrs. Malcolm Tennyson 

114 Stedman St Fayetteville 

Foushee, Mrs. J. Henry Smith, Jr. 

748 Barnesdale Rd Winston-Salem 

Fowler, Mrs. Henry Jackson 

Box 403 Walnut Cove 

Fowler, Mrs. John A. 

1409 Woodbuxn Rd Durham 

Fox, Mrs. Dennis Bryan, McGill Dr., Albemarle 
Fox, Mrs. Norman Albright, Jr. 

Friendly Rd Guilford College 

Fox, Mrs. Norman Albright, Sr. 

Friendly Rd Guilford College 

Fox, Mrs. Powell Graham 

2910 Fairview Rd Raleigh 

Fox, Mrs. Powell Graham, Jr. 

3013 Medlin Drive Raleigh 

Fox, Mrs. Robert Eugene 

1011 E. Main St Albemarle 



42:2 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Fox, Mrs. William Morgan 

435 Charlotte Dr Fayetteville 

Fraasa, Mr.--. Rohei i ( <niia<i 

122(5 Tarrington Dr Charlotte 

Franklin, Mrs. Ernest Washington 

11-11 Linganore PI. Charlotte 

Franklin, Mrs. Robert Benjamin Clinton 

227 Rockford St Mt. Airy 

Frazier, Mrs. Claude Albee 

14 Buena Vista Rd Asheville 

Frazier, Mrs. John Wesley. Jr. 

Pine Tree Rd Salisbury 

Freedman, Mrs. Arthur 

1305 Hobbs Rd Greensboro 

Freeman, Mrs. Percy Lee 

1018 Paramount Circle Gastonia 

Freeman, Mrs. Roy Oscar JclT 

Freeman, Mrs. William Han. i n 

(ill Yadkin St Albemarle 

Freeman, Mrs. William Talmadge 

311 Vanderbilt Rd Asheville 

Fritz, Mrs. Olin Gradv Walkertown 

Fritz, Mrs. William Abel 

636 Third St., N. E. Hickory 

Frizelle. Mrs. Mark Twain, 507 S. Lee St. Ayden 
Frohbose, Mrs. William Joseph 

1524 Beal St Rocky Mount 

Frye, Mrs. Glenn Raymer 

539 N. Center St Hickory 

Fulcher, Mrs. Luther Beaufort 

Fuller, Mrs. David H. 

State Hospital Raleigh 

Fuller, Mrs. Henry Fleming 

1302 Walker Dr Kinston 

Fulp, Mrs. James Francis 

Bryan Street - Stoneyville 

Futch, Mrs. William Alexander 

217 Brentwood Ave Jacksonville 

Gadd, Mrs. Duwayne Douglas 

Linden Road Pinehurst 

Gainey, Mrs. John White, Jr Morehead City 

Gallant, Mrs. Robert Miller 

809 Central Ave Charlotte 

Galloway. Airs. James Hervey 

200 Shepherd St Raleigh 

Galusha, Mrs. Bryant Leroy 

1419 Ferncliff Charlotte 

Gamble, Mrs. John Reeves, Jr. 

Box 270 Lincolnton 

Gambrel, Mrs. Ralph 

546 Wilkesboro St Mocksville 

Garber, Mrs. Edgar Clyde, Jr. 

1810 Lakeshore Dr Fayetteville 

Garrard, Mis. Robert Lemley 

101 N. Park Dr Greensboro 

Garrenton, Mrs. Connell George Bethel 

Garrett, Mrs. John Bostian Walkertown 

Garrett, Mrs. Norman Hessen, Jr. 

3932 Madison Ave Greensboro 

Garrison, Mrs. Paul Leslie 

1837 Buena Vista Winston-Salem 

Garrison, Mrs. Ralph Bernard, Cheraw Rd., Hamlet 
Garrison, Mrs. Robeit Lee 

2118 Beverly Dr Charlotte 

Garvey, Mrs. Fred Kesler 

J .40 Fairfax Dr. Winston-Salem 

Garvey, Mrs. Robert Roby 

Boone Highway Blowing Rock 

Gaskin Mrs. Ernest Reed 

1000 Nottingham Dr Charlotte 

Gaskin, Mrs. Lewis Reed 

274 N. Fourth St Albemarle 

Gaskin, Dr. Madge Baker 

265 N. Third St Albemarle 

Gaul, Mrs. John Stuart, Jr. 

2010 Sharon Lane Charlotte 

Gaul, Mrs. John Stuart, Sr. 

2119 Norton Rd Charlotte 



Gay, Mrs. Charles Houston 

143 Huntley PI Charlotte 

Geddie, Mrs. Kenneth Baxter 

1121 Rotary Dr High Point 

Gee, Airs. William N., Jr. 

1001 S. Madison loldsboro 

Gentry. Mrs. George Wesley Box 14t> Roxboro 

Gentry, Mrs. William Harold 

N. C. Sanatorium McCain 

Georgiade, Mrs. Nicholas G. 

2523 Wrightwood Ave Durham 

Germouth, Mrs. Frederick Geo 

2100 Sherw 1 Ave Charlotte 

Gibbon, Mrs. James Wilson 

720 Bromley Rd Charlotte 

Gibbons, Mrs. Julius Joyce, Jr. 

215 Highland Ave Lenoir 

Gibbs, Mrs. Norfleet M. 

209 Johnson St New Bern 

Gibbs, Mrs. Stuart Wynn 

Armstrong Park Circle Gastonia 

Gibson, Mrs. Milton Reynolds 

105 Chamberlain St Raleigh 

Gibson, Mrs. Thomas G., Jr. .... liib ■ n 

Gilbert, Mrs. George Gaylord 

1 St. Dunstans Rd Asheville 

Gill, Mrs. Joseph Armstrong 

803 River Rd ab i City 

Gilliam, Mrs. James Sylvester, Jr. 

607 W. Lexington Ave High Point 

Gilmore, Mrs. Clyde Manly 

108 E. Avondale Greensboro 

Gilmour, Mrs. Monroe Taylor 

734 Granville Rd Charlotte 

Givens, Mrs. George H., Jr. Taylorsville 

Glasgow, Mrs. Douglas McKay 

2022 Glendale Rd Charlotte 

Glasson, Mrs. John, 615 Swift Ave Durham 

Glenn, Mrs. Channing, Box 335 Elizabethtown 

Glenn, Mrs. Charles Foster 

405 Ridgecrest Ave Rutherfordton 

Glenn, Mrs. Henry Franklin, Jr. 

319 S. Oakland Ave Gastonia 

Glenn, Mrs. John C, Jr. 

200 Hempstead PI Charlotte 

Glenn, Mrs. Richard Reece 

2507 Miller Park CI Winston-Salem 

Gobble. Mrs. Fleetus Lee, Jr. 

925 S. Hawthorne Rd Winston-Salem 

Godwin, Mrs. Harold Lacy 

1811 Lakeshore Dr Fayetteville 

Gold, Mrs. Ben Miller, Jr. 

Country Club Dr Rocky Mount 

Goldner, Mrs. J. Leonard 

602 E. Forest Hills Blvd Durham 

Goley, Mrs. Willard Coe, 217 N. Main St Graham 

Goode, Mrs. Thomas Vance, III 

326 Summit Ave Statesville 

Gooding, Mrs. Guy U Kenansville 

Goodman, Mrs. Benjamin Warren 

226 Fifth St., S. E Hickory 

Goodwin, Mrs. Cleon Walton 

1107 W. Nash St Wilson 

Goodwin, Mrs. Oscar Sexton. Raleigh Rd Apex 

Googe, Mrs. James Turner 

335 Grand Boulevard Boone 

Gore, Mrs. John Pratt 

957 Lambeth Circle Durham 

Goswick, Mrs. Claude Benjamin 

1747 Clairmont Drive Hendersonville 

Goswick. Mrs. Harry Wilson. Jr. 

280 Canterbury Trail Winston-Salem 

Gradis, Mrs. Howard Henry- 
Forest Hill Drive Greenville 

Grady, Mrs. Edward Stephen, Box 447 ....Smithfield 
Grady, Mrs. Franklin McLean 

Madam Moore's Lane New Bern 






September, 1960 



ROSTER OP MEMBERS 



423 



Grady, Mrs. Leland Vaine 

1527 W. Nash St Wilson 

Graham, Mrs. Charles Pattison 

123 Forest Hills Dr Wilmington 

Graham, Mrs. John Borden 

Roosevelt Rd Chapel Hill 

Graham, Mrs. Walter Raleigh 

741 Hempstead PI Charlotte 

Graham, Mrs. William Alexander 

2247 Cranford Rd Durham 

Gray, Mrs. Cyrus Leighton 

912 Rotary Dr High Point 

Green, Mrs. Harold David 

1172 Hawthorne Rd Winston-Salem 

Green, Mrs. Philip Palmer 

435 E. Indiana Ave Southern Pines 

Greene, Mrs. Phares Yates 

1004 E. Willowbrook Dr Burlington 

Greene, Mrs. William Alexander 

500 Pinkney St Whiteville 

Greenwood, Mrs. James Brooks, Jr. 

2319 Providence Rd Charlotte 

Gregg, Mrs. Robert A. 

3411 Cloverdale Dr Greensboro 

Gregory, Mrs. John Eugene 

521 Confederate Ave Salisbury 

Gregory, Mrs. R. D., Jr. 

105 Kimberly Knoll Asheville 

Gregory, Mi's. William Lvon 

120 Easton Burton Hill .Lowell 

Gridley, Mrs. Timothy H. 

820 Carolina Ave Fayetteville 

Grier, Mrs. Charles Talmadge, Box 475 ...Carthage 
Grier, Mrs. John Calvin, Jr. 

Midland Road Pinehurst 

Griffin, Mrs. Harold Walker 

537 N. Center St Hickory 

Griffin, Mrs. Mark Alexander, Jr. 

11 Forrest Rd Asheville 

Griffin, Mrs. Robert Ashlev 

11 Hilltop Rd Asheville 

Griffin, Mrs. Thomas Ray, Box 328 Troutman 

Griffin, Mrs. William Rav, Jr. 

30 Hilltop Rd Asheville 

Griffin, Mrs. William Ray, Sr. 

8 Edwin Place Asheville 

Griffis, Mrs. John William, Box 191 Denton 

Griggs, Mrs. Bovce Powell 

811 N. Oak St Lincolnton 

Griggs, Mrs. Willard Wilson, Box 217 Norwood 

Grim, Mrs. Kenneth Boyd, 1421 Broad St. Durham 
Grimmett, Mrs. Matthew Hill 

107 Country Club Dr Concord 

Groome, Mrs. James Gordon 

203 Edgedale Dr High Point 

Gross, Mrs. Francis Warren 

408 W. Lexington Ave ...High Point 

Grove, Mrs. Raymond Fisk 

1400 Live Oak Pkwy Wilmington 

Groves, Mrs. Robert Burwell, Sr Lowell 

Groves, Mrs. Robert Burwell, Jr. 

2565 Pinewood Drive Gastonia 

Gulley, Mrs. Marcus Marcellus 

Faculty Apartments Winston-Salem 

Gunn, Mrs. Charles Groshon 

972 Kenleigh Circle Winston-Salem 

Gunter, Mrs. June U. 

1411 N. Mangum St. Durham 

Gwynn, Mrs. Houston Lafayette, Box 6, Yanceyville 

Haar, Mrs. Frederick Behrend 

608 E. 9th St Greenville 

Hackney, Mrs. Ben H Lucama 

Hadley, Mrs. Herbert Wood 

2607 S. Dickinson Ave Greenville 

Hagaman, Mrs. John Bartlett, Jr. 

304 North St Boone 



Hagaman, Mrs. Len Doughton 

101 Cherry Dr _ Boone 

Haines, Mrs. Hilton Drummond 

700 E. Washington St Rockingham 

Haines, Mrs. Innes Correll 

818 Anarine Rd Fayetteville 

Hairfield, Mrs. Beverly Dew 

415 W. Union St Morganton 

Hairfield, Mrs. Theodore Vincent 

404 Westview St Lenoir 

Hall, Mrs. James Brownlee Matthews 

Hall, Mrs. John Moir, W. Main St Elkin 

Hall, Mrs. Joseph Cullen 

839 Fairmont Ave Salisbury 

Hall, Mrs. William Bruce, Jr. 

543 Vista Dr Fayetteville 

Hall, Mrs. William Dewey 

510 Washington St Roanoke Rapids 

Hall, Mrs. William Hugh 

3635 Barclay Downs Dr Charlotte 

Ham, Mrs. Clem, West Blvd Laurinburg 

Ham, Mrs. George Calverno 

519 Dogwood Dr Chapel Hill 

Hambrick, Mrs. Robert Theodore 

529 Sixth St., N. W Hickory 

Hambright, Mrs. Rufus Roberts 

1809 Elkhart Dr Greensboro 

Hamer, Mrs. Alfred Wilson 

112 Pearson Dr Morganton 

Hamer, Mrs. Douglas, Jr. 

205 Norwood St Lenoir 

Hamer, Mrs. Eugene Floyd, P. O. Box 476 ....Monroe 
Hamilton, Mrs. Alfred Thomason 

1422 Canterbury Rd Raleigh 

Hamilton, Mrs. Frank Hutchinson, Jr. 

2815 Marlowe Dr. ..._ _ Charlotte 

Hamilton, Mrs. John Homer 

2124 Cowper Dr Raleigh 

Hamilton, Mrs. Joseph Franklin, Jr. 

Albemarle Circle Asheville 

Hammond, Mrs. Alfred Franklin, Jr. 

1514 Neuse Blvd New Bern 

Hamrick, Mrs. John Carl, 1002 Kings Rd Shelby 

Hamrick, Mrs. Ladd Watts, Jr. 

103 Country Club Dr Concord 

Hamrick, Mrs. Robert Arnold 

927 Hill St Rocky Mount 

Hand, Mrs. Edgar Hall Pineville 

Hand, Mrs. LeRoy Corbett, Jr Gatesville 

Hanes, Mrs. Gideon Isaac, Jr. 

836 Wellington Road Winston-Salem 

Happer, Mrs. William 

205 Woodsway Lane Lenoir 

Harbison, Mrs. John William 

911 N. Washington St Shelby 

Hardaway, Mrs. John Stegar 

434 Oakwood Dr Statesville 

Hardin, Mrs. Eugene Ramsey 

1103 N. Elm St Lumberton 

Hardin, Mrs. Richard Henry 

S. Granville St Edenton 

Hardin, Mrs. Ronda Horton 

Wilkesboro Rd Boone 

Hardison, Mrs. Lewis Benjamin 

113 Star Hill Rd _ Fayetteville 

Hardman, Mrs. Edward Francis 

Route 2, Huntington Park Charlotte 

Hare, Mrs. Roy Allen, 1023 Sycamore St Durham 

Harer, Mrs. Adolph Eugene 

1609 Canterbury Rd Raleigh 

Hargrove, Mrs. Eugene Alexander 

713 Greenwood Rd Chapel Hill 

Harloe, Mrs. John Pincknev 

669 Hempstead PI Charlotte 

Harmon, Mrs. Raymond Harris 

Highland Dr Boone 



424 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1060 



Harper, Mrs. Matt C, Jr. 

Caswell Training School Kinston 

Harper, Mrs. Robert N. 

3322 Ocatea Drive Raleigh 

Harrell, Mrs. William Fletcher, Jr. 

Brother's Dr Elizabeth City 

Harrill, Mrs. Henry Clay 

100 Elmwood Terrace Greensboro 

Harrill, Mrs. James Albert 

2860 Reynolds Rd Winston-Salem 

Harrington, Mrs. Lee I., Jr. 

2423 Fairway Dr Winston-Salem 

Harris, Mrs. Carlton McKenzie 

204 Meadowbrook Terr Greensboro 

Harris, Mrs. Charles Isaac, Jr. 

500 School Drive Williamston 

Harris, Mrs. Charles Theodore, Jr. 

425 Roberts Rd Salisbury- 
Harris, Mrs. Isaac Emerson, Jr. 

3900 Dover Rd., Hope Valley Durham 

Harris, Mrs. Julian L. 

1660 Mansfield Rd Winston-Salem 

Harris, Mrs. Loftin Howell 

417 East St Albemarle 

Harris, Mrs. Tyndall Peacock 

410 Westwood Dr Chapel Hill 

Harry, Mrs. John McKamie 

832 W. Rowan St Fayetteville 

Hart, Mrs. Julian Deryl 

Duke University Rd. Durham 

Hart, Mrs. Lillard Franklin, 236 E. Olive ... Apex 
Hart, Mrs. Oliver James 

1930 Georgia Ave Winston-Salem 

Hart, Mrs. Verling Kersey 

106 W. 7th St Charlotte 

Hartman, Mrs. Bernhard Henry 

12 Cambridge Rd Asheville 

Hartness, Mrs. William Rufus, Jr. 

615 Carr St Sanford 

Hatcher, Mrs. Samuel W Morehead City 

Hawes, Mrs. Cecil Jennings 

2101 Wendover Rd Charlotte 

Hawes, Mrs. George Aubrey 

1862 Queens Rd. W Charlotte 

Hawkins, Mrs. Barry Fugh 

330 Sunset Dr Concord 

Hawkins, Mrs. Hal Burgess Moravian Falls 

Hawkins, Mrs. James Hubert Alamance 

Hayes, Mrs. James Willard 

Lake View Rd Fairmont 

Hayes, Mrs. William Clayton 

Woodland Blvd Wilkesboro 

Hayman, Mrs. Louis DeMaro, Jr. 

203 W. Bayshore Blvd Jacksonville 

Haywood, Mrs. Hubert Benbury, Jr. 

2718 Gloucester Rd Raleigh 

Heafner, Mrs. Bob O Stony Point 

Hedgepeth, Mrs. Emmett Martin 

Crestwood Dr Roxboro 

Hedgpeth, Mrs. Edward McGowan 

Rt. 3, Box 87 Chapel Hill 

Hedgpeth, Mrs. Louten Rhodes 

1917 N. Walnut St Lumberton 

Hedgpeth, Mrs. William Carey 

2405 Kenan St Lumberton 

Hedrick, Mrs. Clyde Reitzel 

318 E. College Ave Lenoir 

Hedrick, Mrs. Richard Eli 

1999 Georgia Ave Winston-Salem 

Hege. Mrs. John Roy, Martin Drive Concord 

Heinitsh, Mrs. George W. 

Knollwood Southern Pines 

Helms, Mrs. Jefferson Bivins 

319 W. Union St Morganton 

Helsabeck, Mrs. Belmont Augustus 

2315 Country Club Rd Winston-Salem 



Helsabeck, Mrs. Chester Joseph 

Box 236 Walnut Cove 

Hemmings, Mrs. Hugh Carroll 

Lurawood Dr Morganton 

Hemphill, Mrs. Clyde Hoke 

P. O. Box 1084 Black Mountain 

Hemphill, Mrs. James Eugene 

2002 Pinewood Circle Charlotte 

Henderson, Mrs. John Percy, Sr. 

417 College St Jacksonville 

Henderson, Mrs. John Percy, Jr. 

107 Warlick St Jacksonville 

Hendrick, Mrs. Harry Vance 

404 S. Ridgecrest Ave Rutherfordton 

Hendricks, Mrs. Paul Eugene 

808 W. Mountain St Kings Mountain 

Hendrix, Mrs. James Paisley 

144 Pinecrest Rd Durham 

Henry, Mrs. Hector H. 

3535 Providence Rd Charlotte 

Henry, Mrs. Russell Cole, 1545 Kings Road, Shelby 
Henschen, Mrs. Hal 

1309 General Lee Ave Fayetteville 

Henson, Mrs. Thomas Albert 

1105 Country Club Dr Greensboro 

Herrin, Mrs. Keith Hermon 

1204 Fairfield Dr Gastonia 

Herrin, Mrs. William Benjamin 

Carolyn Drive Albemarle 

Herring Mrs. Theodore Tilghman 

Ripley Road Wilson 

Hester, Mrs. Joseph Robert 

1 Buffalo St Wendell 

Hester, Mrs. William Shepherd 

802 Main St Reidsville 

Hewitt, Mrs. Willard Chappel 

W. Front St. Ext Burlington 

Hiatt, Mrs. Joseph Spurgeon, Jr. 

Box 85 Southern Pines 

Hicks, Mrs. Vonnie Monroe, Jr. 

1515 Scales St Raleigh 

Higgins, Mrs. Robert Donald 

1204 Cowper Dr Raleigh 

High, Mrs. Larry Alison Nashville 

Highsmith, Mrs. Charles, Jr Troy 

Highsmith, Mrs. William Cochran 

220 Bradford Ave Fayetteville 

Hightower, Mrs. Felda 

2455 Reynolds Drive Winston-Salem 

Hilderman, Mrs. Walter Carrington, Jr. 

1724 Brandon Rd Charlotte 

Hill, Mrs. Millard D. Hill 

818 Daniels St. Raleigh 

Hill, Mrs. William Henry 

115 E. South St Albemarle 

Hipp, Mrs. Edward Reginald, Sr. 

348 Hempstead PI Charlotte 

Hitch, Mrs. Joseph Martin, 918 Cowper Dr. Raleigh 
Hobart, Mrs. Seth Guilford, Jr. 

2011 W. Club Blvd Durham 

Hodges, Mrs. Horace Havden 

423 Ferncliff Rd Charlotte 

Hoggard, Mrs. William Alden, Jr. 

2501 Rochelle Elizabeth City 

Hogshead, Mrs. Ralph, Jr., W. Park Dr., Morganton 
Hoke, Mrs. Harold Reid 

1605 Oaklawn Dr. ..._ Greenville 

Holbrook, Mrs. Joseph Samuel 

223 N. Oak St Statesville 

Holbrook, Mrs. William Douglas 

2518 Danbury St Charlotte 

Hollandsworth, Mrs. Luther Clarence 

305 E. 18th St Lumberton 

Hollister, Mrs. William Fredwin 

Midland Rd Southern Pines 

Hollowell, Mrs. Victor Boyce 

515 Fenton PI Charlotte 



September, 1960 



ROSTER OF MEMBERS 



425 



Hollyday, Mrs. William Murray 

51 Lawrence PI Asheville 

Holmes, Mrs. George Washington 

524 Roslyn Rd Winston-Salem 

Holt, Mrs. Lawrence Byerly 

2812 Reynolds Dr Winston-Salem 

Hood, Mrs. Christopher Kennedy 

5143 Beckford Dr. „._ Charlotte 

Hood, Mrs. Richard Thornton, Jr. 

1109 Carey Rd Kinston 

Hooks, Mrs. Richard Eugene St. Pauls 

Hooper, Mrs. Joseph Ward, Jr. 

2600 Parmelee Dr Wilmington 

Hooper, Mrs. Joseph Ward, Sr. 

1817 Market St. Wilmington 

Hoot, Mrs. Melvin Phillip 

1505 E. 5th St Greenville 

Horner, Mrs. Jack Chenoweth .Spruce Pine 

Hornowski, Mrs. Marcel Jerome 

317 Charlotte St Asheville 

Horsley, Mrs. Thomas Martin Elizabeth City 

Horsley, Mrs. William Nolen 

South Point Rd Belmont 

Hoskins, Mrs. John Robinson, III 

36 Evelyn PI Asheville 

Hoskins, Mrs. William Hume 

Fuller St Whiteville 

Hough, Mrs. Mac Johnson 

3234 Park Rd Charlotte 

Houghton, Mrs. Raymond C. 

1800 River Dr New Bern 

Houser, Mrs. Forest Melville, Elm St., Cherryville 
Hovis, Mrs. Leighton Watson 

810 Berkeley Ave Charlotte 

Howard, Mrs. Corbett Etheridge 

618 E. Park Ave Goldsboro 

Howard, Mrs. Joseph Cooper, Jr. 

Lafayette St Clinton 

Howard, Mrs. Paul Osman 

Carbonton Hgts Sanford 

Howell, Mrs. Charles Maitland, Jr. 

515 Lester Lane Winston-Salem 

Howell, Mrs. Julius Amnions 

2662 Robin Hood Rd Winston-Salem 

Howell, Mrs. William Lawrence Ellerbe 

Howerton, Mrs. James R Columbia 

Hubbard, Mrs. Frederick Cecil, Sr Wilkesboro 

Hubbard, Mrs. Robert Thomas 

126 Lakeshore Dr. Asheville 

Huckeriede, Mrs. Mark Henry 

Anson Ave Laurinburg 

Hudson, Mrs. Miles Hildebrand 

240 Bouchard St Valdese 

Huey, Mrs. Thomas Walker, Jr. 

2438 Sharon Rd Charlotte 

Huffines, Mrs. Thomas Ruffin 

16 Hilltop Rd Asheville 

Huffman, Mrs. Stanton Vance 

Route 2 Elon College 

Hughes, Mrs. Carlisle Bee, Jr. 

Box 326 Yadkinville 

Hughes, Mrs. Jack 

Route 2, Box 336 Durham 

Humphries, Mrs. Charles Oliver 

Summerset Road ..Durham 

Huneycutt, Mrs. Joel Broadus 

627 Yadkin St Albemarle 

Hunt, Mrs. Jasper Stewart 

2064 Queens Rd., E Charlotte 

Hunt, Mrs. Walter Skellie, Jr. 

1606 Canterbury Rd Raleigh 

Hunt, Mrs. William Jack 

720 Ferndale Dr High Point 

Hunter, Mrs. John Pullen 

325 S. Academy St Cary 

Hunter, Mrs. W. Myers 

800 E. Blvd Charlotte 



Hunter, Mrs. William Blair 

1007 10th St Lillington 

Hunter, Mrs. William Cooper 

1106 W. Nash St Wilson 

Hurdle, Mrs. Samuel Walker 

2571 Country Club Rd Winston-Salem 

Hurdle, Mrs. Thomas Gray 

212 Fuller St Fayetteville 

Hutchinson, Mrs. Sankey Smith Bladenboro 

Hyde, Mrs. Austin Tabor, Jr. 

Union Road Rutherfordton 

Inman, Mrs. Charles Ernest 

Fisher Park Fairmont 

Irving, Mrs. Richard Carroll 

601 4th Ave. W Hendersonville 

Irwin, Mrs. Henderson Eureka 

Isenhower, Mrs. Joseph Andrew 

232 Fifth St., S. E Hickory 

Izlar, Mrs. Henrv LeRoy, Jr. 

2202 Sprunt St Durham 

Jackson, Mrs. Marshall Vaden, Box 87, Princeton 
Jackson, Mrs. Richard DeWitt 

909 S. Rockford St Mt. Airy 

Jackson, Mrs. Robert Toombus 

3347 Alamance Dr Raleigh 

Jackson, Mrs. Roger A. 

111-A Dobbin Ave Fayetteville 

Jacobs, Mrs. Julian Erich John 

2000 Providence Rd Charlotte 

James, Mrs. Arthur Augustus, Jr. 

614 Spring Lane Sanford 

James, Mrs. George W. 

1020 Wellington Rd Winston-Salem 

James, Mrs. Richard Thomas, Jr. 

2300 Wendover Rd Charlotte 

James, Mrs. William Daniel, Vance St Hamlet 

James, Mrs. William Duer, Jr. 

306 Entwistle St Hamlet 

Jarman, Mrs. Fontaine Graham, Sr. 

402 Hamilton St Roanoke Rapids 

Jarman, Mrs. Fontaine Graham, Jr. 

429 Sunset Ave Roanoke Rapids 

Jarrel, Mrs. Wilburn Eric 

329 Country Club Rd Mt. Airy 

Jarvis, Mrs. James Luther 

1003 Woodland Drive Gastonia 

Jenkins, Mrs. Albert Milton 

823 Bryan St Raleigh 

Jennings, Mrs. Royal Green 

724 Florham Ave High Point 

Jensen, Mrs. Milton Baker 

152 Milford Dr Salisbury 

Jervey, Mrs. William St. Julien 

907 Elizabeth Rd Shelby 

Johnson, Mrs. Amos Neill Garland 

Johnson, Mrs. Charles Thomas, Jr Red Springs 

Johnson, Mrs. Charles Thomas, Sr. ...Red Springs 

Johnson, Mrs. Floyd, 201 Pinkney St Whiteville 

Johnson, Mrs. Gale Denning 

400 W. Broad St Dunn 

Johnson, Mrs. Gaston Frank 

3225 Nottingham Rd Winston-Salem 

Johnson, Mrs. George, Jr., 1312 Watts St., Durham 

Johnson, Mrs. Harry Lester, Box 530 Elkin 

Johnson, Mrs. Heber Wellington 

3002 Wayne Dr. Wilmington 

Johnson, Mrs. James Trimble 

312 E. 16th Lumberton 

Johnson, Mrs. John Ralph, N. Orange St Dunn 

Johnson, Mrs. Joseph A. 

Winslow Acres Elizabeth City 

Johnson, Mrs. Joseph Lewis 

205 N. Main St Graham 

Johnson, Mrs. Paul William 

Route 8, Green Meadows Winston-Salem 

Johnson, Mrs. Philip Martyn 

220 Hayes St Chapel Hill 



426 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Johnson, Mrs. Robert Charles 

701 Locust St High Point 

Johnson, Airs. Walter Royle 

3 Fairway Place Asheville 

Johnson, Mrs. Wingate Memory 

428 Stratford Rd Winston-Salem 

Johnston, Mrs. Frank Randolph 

735 Arbor Rd Winston-Salem 

Johnston, Mrs. Harvey Wylie 

1915 Club Rd Charlotte 

Johnston, Mrs. James William 

508 Wildwood Lane Burlington 

Johnston, Mrs. Robert Lee 

218 N. Patrick St Leaksville 

Johnston, Mrs. William Oliver 

2611 Forest Dr Charlotte 

Jones, Mrs. Beverly Nicholas, Jr. 

633 Barnesdale Rd Winston-Salem 

Jones, Mrs. Beverly Nicholas, Sr. 

455 Carolina CI Winston-Salem 

Jones, Mrs. Carey C, S. Salem St Apex 

Jones, Mrs. Claude M., 509 E. 4th St., Greeenville 
Jones, Mrs. Clayton Joe, 873 Arbor Lane, Concord 
Jones, Mrs. Craig Strickie 

Westfield Road Shelby 

Jones, Mrs. Dean Cicero Jefferson 

Jones, Mrs. Donnie Hue, Jr., Box 67 Princeton 

Jones, Mrs. Edward L. 

400 Randolph St Thomasville 

Jones, Mrs. Frank Woodson 

Westlake Hills Newton 

Jones, Mrs. Joseph Kempton 

109 E. Boundary St Chapel Hill 

Jones, Mrs. Joseph Reid, Jr., Box 298 King 

Jones, Mrs. Martin Evans Granite Falls 

Jones, Mrs. Otis Hunter 

1710 Queens Rd. W Charlotte 

Jones, Mrs. Paul Erastus 

Rt. 3, Box 452A Concord 

Jones, Mrs. Robert Spurgeon 

405 Beaumond Shelby 

Jones, Mrs. Thomas Thweatt 

2621 Stuart Dr Durham 

Jones, Mrs. William Robert 

217 Clifton Rd Rocky Mount 

Jordan, Mrs. John Alfred, Jr. 

236 Pinecrest Dr Fayetteville 

Jordan, Mrs. Riley Moore 

310 Fulton St. Ext Raeford 

Jordan, Mrs. Weldon Huske 

601 Westmont Dr Fayetteville 

Joyce, Mrs. Charles Weldon 

617 Decatur Madison 

Joyner, Mrs. William Stafford 

401 Whitehead Circle Chapel Hill 

Judd, Mrs. Glenn Ballentine Varina 

Justa, Mrs. Samuel Harry 

505 Piedmont Ave Rocky Mount 

Justice, Mrs. William Shipp 

14 White Oak Rd Asheville 

Justis, Mrs. Homer Rodeheaver 

820 Fairbanks Rd Charlotte 

Kalevas, Mrs. Harry John 

5415 Wedgewood Dr Charlotte 

Katz, Mrs. Joseph, Kinston Apts Kinston 

Kearse, Mrs. William Oliver Canton 

Keathley, Mrs. Franklin Burr 

206 Grove Ave Lenoir 

Keever, Mrs. James Woodfin 

623 Second Ave., N. W Hickory 

Keiter, Mrs. William Eugene 

1507 Perry Park Dr Kinston 

Keith, Mrs. Julian Faison, Jr., Box 635, Clarkton 
Keith, Mrs. Marion Yates 

1603 Carlisle Rd Greensboro 

Keleher, Mrs. Michael Francis 

18 Maywood Rd Asheville 



Kelemen, Mrs. William Arthur 

1206 Kennilworth Ave Charlotte 

Keller, Mrs. Guy Otis 

1223 Providence Charlotte 

Kelley, Mrs. Thomas Francis 

805 Montgomery Ave Albemarle 

Kelly, Mrs. Luther Wrentmore, Jr. 

3915 Shelton Place Charlotte 

Kelly, Mrs. Luther Wrentmore, Sr. 

1014 Kenilworth Ave Charlotte 

Kelly, Mrs. Richard Alexander 

308 N. Chapman Greensboro 

Kemp, Mrs. Malcolm Drake 

210 Highland Rd Southern Pines 

Kenan, Mrs. LeRoy Fulton 

22 Henderson St. Badin 

Kendall, Mrs. Benjamin Horton 

116 Belvedere Ave Shelby 

Kendall, Mrs. John Harold 

800 Stewart Ave. Clinton 

Kendriek, Mrs. Charles Mattox 

103 Poplar St Lenoir 

Kendriek, Mrs. Richard L. 

2500 Roswell Ave Charlotte 

Kennard, Mrs. John William 

Maple St Blowing Rock 

Kennedy, Mrs. John Pressly 

2026 Providence Rd Charlotte 

Kennedy, Mrs. Leon Toland 

1907 Sterling Rd Charlotte 

Kennel, Mrs. Arthur J Jefferson 

Kent, Mrs. Alfred A., Jr Granite Falls 

Kermon, Mrs. Louis Todd 

1625 Canterbury Rd Raleigh 

Kern, Mrs. John Campbell, Box 6 Booneville 

Kernodle, Mrs. Charles Edward, Jr. 

444 Tarleton Ave Burlington 

Kernodle, Mrs. Donald Reid 

1-D Brookwood Garden Apts Burlington 

Kernodle, Mrs. Dwight Talmadge 

Route 2 Elon College 

Kernodle, Mrs. Harold Barker 

423 Glenwood Ave Burlington 

Kernodle, Mrs. John Robert 

Edgewood Ave. Ext Burlington 

Kems, Mrs. Thomas Cleveland, Sr. 

120 Briar Cliff Rd Durham 

Kerns, Mrs. Thomas Cleveland, Jr. 

1118 Wells St Durham 

Kerr, Mrs. George Russell 

Woodland Ave. Ext Burlington 

Kerr, Mrs. John Guthrie Leicester 

Kerr, Mrs. Joseph T. 

1423 Kenan Ave Wilson 

Kesler, Mrs. Robert Cicero 

705 Twyckenham Dr Greensboro 

Kester, Mrs. John Marcas, Jr. 

2935 Avondale Ave Charlotte 

Ketner, Mrs. Fred Yadkin 

185 Washington Lane Concord 

Keys, Mrs. Carson Meade West Jefferson 

Kibler, Mrs. William Herbert 

100 Valdese Ave Morganton 

Kidd, Mrs. Ralph Vincent, Jr. 

1227 Canterbury Rd Charlotte 

King, Mrs. Daniel, 611 Maple Ave Reidsville 

King, Mrs. Edward Sandling, Wesson Road, Shelby 
King, Mrs. Francis Parker 

1603 Lucerne Way New Bern 

King, Mrs. Parks McCombs 

1419 Wendover Lane Charlotte 

King, Mrs. Robert Wilson 

113 Dobbin Ave Fayetteville 

King, Mrs. Walter Gorringe 

1305 Latham Rd - Greensboro 

Kinlaw, Mrs. Murray Carlyle 

202 W. 21st St Lumberton 



September, 1960 



ROSTER OF MEMBERS 



427 



Kirby, Mrs. William Leslie 

734 Arbor Rd Winston-Salem 

Kirkland, Mrs. John Alvin, 715 Trinity Dr., Wilson 

Kirksey, Mrs. James Jackson 

Riverside Dr Morganton 

Kirksey, Mrs. William Albert 

302 S. King St Morganton 

Kistler, Mrs. Clark Clemmons 

2212 St. Mary's St Raleigh 

Kitchin, Mrs. Thurman Delna 

413 N. Main St Wake Forest 

Kitchin, Mrs. William Walton 

Coharie Dr Clinton 

Klenner, Mrs. Fred Robert Reidsville 

1205 Forest Road Reidsville 

Klostermyer, Mrs. Louis Leon 

419 Vanderbilt Rd Asheviiie 

Kneedler, Mrs. William Harding, Box 397, Davidson 
Knight, Mrs. Floyd Lafayette, Route 4, Sanford 
Knoefel, Mrs. Arthur Eugene, Jr. 

104 Laurel Circle Black Mountain 

Knox, Mrs. Joseph Clyde 

1228 S. Live Oak Parkway Wilmington 

Kodack, Mrs. Albert 

9 N. Kensington Rd Asheviiie 

Koon, Mrs. Ethen Sease, Jr. 

159 Kimberly Ave Asheviiie 

Koonce, Mrs. Donald Brock 

1407 Oleander Dr Wilmington 

Kornegay, Mrs. Robert Dumais 

1418 Lafayette Ave Rocky Mount 

Koseruba, Mrs. George Michael 

18 E. Fayetteville Wrightsville Beach 

Kramer, Mrs. Morris 

503 Walnut St Lumberton 

Kroh, Mrs. Laird Franklin 

2201 McClintock Rd Charlotte 

Kroncke, Mrs. Fred George 

623 Cedar St Roanoke Rapids 

Kurtz, Mrs. Elam Jefferson 

Kutscher, Mrs. George William 

29 Elk Mountain Scenic Hwy Asheviiie 

Kutteh, Mrs. Hanna Constantine 

567 Lakeside Dr Statesville 

Kyles, Mrs. Norman Bruce 

State Hospital Goldsboro 

Lackey, Mrs. Robert Stevenson 

3931 Shelton PI Charlotte 

Lackey, Mrs. Walter Jackson Fallston 

Lacy, Mrs. Thomas Allen 

608 S. Fulton St Salisbury 

Lafferty, Mrs. John Ogden 

2059 Briarwood Road Charlotte 

Lafferty, Mrs. John William 

1055 Fourth Ave., N.W Hickory 

Lahser, Mrs. Charles Irvin 

1212 Crescent Ave Gastonia 

Lake, Mrs. Ralph Callihan 

4500 Starmount Dr Greensboro 

Lambeth, Mrs. William Arnold, Jr. 

Route 8 Winston-Salem 

Lampley, Mrs. Charles Gordon. Fairway Dr., Shelby 
Lampley, Mrs. William Askew 

116 Briarwood Lane Hendersonville 

Landon, Mrs. Henry C, III 

611 Eighth St North Wilkesboro 

Lane, Mrs. Edgar Winslow, Jr. 

Bouchard St. Valdese 

Lang, Mrs. Andrew Martin 

106 N. Anderson St Morganton 

Langdell, Mrs. Robert Dana 

11 William Circle Chapel Hill 

Langdon, Mrs. Benjamin Bruce 

Route 3, Box 40 Fayetteville 

Lapsley, Mrs. Alberti Fraser, 4 Tallassee St., Badin 
Large, Mrs. Hiram Lee, Jr. 

Route 1, Box 358-B Matthews 



Larkin, Mrs. Ernest Wadill, Jr. 

1202 Respass St Washington 

Lassiter, Mrs. James Alexander 

Country Club Rd Weldon 

Lassiter, Mrs. Tallie E Biscoe 

Lassiter, Mrs. Will Hardee, Jr. 

709 Sunset Dr Smithfield 

Latham, Mrs. Joseph Roscoe 

1301 National Ave New Bern 

Laton, Mrs. James Franklin 

116 E. North St Albemarle 

La Tourette, Mrs. Kenneth Abran, Hendersonville 
Lawing, Mrs. Karl Lander 

327 N. Laurel St Lincolnton 

Lawrence, Mrs. Benjamin Jones 

Ashton Hall Pace, Virginia 

Lawrence, Mrs. Benjamin Jones, Jr. 

S. 915 Rockford St Mt. Airy 

Lawrence, Mrs. John Charles 

1200 N. Elm Lumberton 

Lea, Mrs. James Walter, Jr. 

721 W. Davis St Burlington 

Leath, Mrs. MacLean Bacon Archdale 

LeBauer, Mrs. Maurice Leon 

2223 St. Andrews Rd Greensboro 

LeBauer, Mrs. Sidney Ferring 

910 Cornwallis Dr Greensboro 

Ledbetter, Mrs. James McQueen 

701 E. Washington St Rockingham 

Lee, Mrs. Allen Henry, 309 N. Massey Selma 

Lee, Mrs. Ferdinand Wayne 

442 Hempstead Charlotte 

Lee, Mrs. Francis Brown, Pageland Rd Monroe 

Lee, Mrs. Thomas Leslie, Rountree St Kinston 

LeGrand, Mrs. Robert Hampton 

2014 Pembroke Rd Greensboro 

Leinbach, Mrs. Lawrence Brickenstein 

260 Kenleigh Circle Winston-Salem 

Lennon, Mrs. Hershel Clanton 

911 Sunset Dr Greensboro 

Lentz, Mrs. Clarence Manteo 

317 N. Fifth St Albemarle 

Leonard, Mrs. Jacob Calvin, Jr. 

Box 566 Lexington 

Leonard, Mrs. Walter Evan 

104 27th St., N.W Hickory 

Levi, Mrs. George Albert 

605 Pearl St Fayetteville 

Lewis, Mrs. Charles Pell, Jr. 

813 S. Main Reidsville 

Lewis, Mrs. Clifford Whitfield 

322 Woodrow High Point 

Lewis, Mrs. John Sumter 

362 N. Center St Hickory 

Lewis, Mrs. Martin Thomas Beaufort 

Lewis, Mrs. Robert Edward 

Finley Park North Wilkesboro 

Lide, Mrs. Thomas Norwood 

601 Barnsdale Rd Winston-Salem 

Ligon, Mrs. Harold Belton 

43 Beverly Apt Asheviiie 

Liles, Mrs. George Welch, 257 Louise Ave., Concord 
Liles, Mrs. Lonnie Carl 

3025 Randolph Dr Raleigh 

Lilly, Mrs. James M. 

226 Bradford Rd Fayetteville 

Lilly, Mrs. William Harold, Benson Highway, Dunn 
Lindsay, Mrs. Robert Boyd 

730 Gimghoul Rd Chapel Hill 

Lindsey, Mrs. Mark McDonald 

415 Minturn Ave Hamlet 

Link, Mrs. Melvin Robert 

1050 Ardsley Rd Charlotte 

Little, Mrs. Howard Q. L., Box 205 Gibsonville 

Little, Mrs. Joseph Rice, Oak Rd Salisbury 

Littlejohn, Mrs. James Talmadge 

8 Cedarcliff Rd Asheviiie 



428 



NORTH CAROLINA .MEDICAL JOURNAL 



September, 1960 



Littlejohn, Mrs. Thomas Willard 

2402 Forest Dr Winston-Salem 

Littleton, Mrs. Leonidas Rosser, Jr Mt. Airy 

Liverman, Mrs. Henry Joseph Engelhard 

Liverman, Mrs. Joseph Thomas Nashville 

Llewellyn, Mrs. Charles Elroy, Jr. 

3525 Hamstead Court Durham 

Lock, Mrs. Frank Ray 

1819 Buena Vista Rd Winston-Salem 

Lockhart, Mrs. David Armistead 

Rt. 3, Burrage Rd Concord 

Lockhart, Mrs. Walter Samuel, Jr. 

2408 Highland Ave Durham 

Lodmell, Mrs. Elmer Arthur 

1308 Cornwallis Greensboro 

Logan, Mrs. Frank William Hicks 

1007 N. Washington Rutherfordton 

Lomax, Mrs. Donald Henry 

1125 Emerald St Salisbury 

London, Mrs. Arthur Hill, Jr. 

Shepherd and Wells Sts Durham 

Long, Mrs. Benjamin Leroy Glen Alpine 

Long, Mrs. David Thomas 

405 S. Main St Roxboro 

Long, Mrs. Glenn, 630 N. Main St Newton 

Long, Mrs. Thomas Drumwright 

513 S. Lamar St. Roxboro 

Long, Mrs. Thomas Walter, N. Main St., Newton 
Long, Mrs. Vann McKee 

1021 West End Blvd Winston-Salem 

Long, Mrs. William Lunsford, Jr. 

1103 Cowper Dr Raleigh 

Long, Mrs. William Matthews Mocksville 

Long, Mrs. Zachary Filmore 

214 Ann St Rockingham 

Longino, Mrs. Frank Henry 

1914 Forest Hill Dr Greenville 

Lore, Mrs. Ralph Eli, 407 Pennton Ave Lenoir 

Lott, Mrs. William Clifton 

310 Vanderbilt Rd Asheville 

Lounsbury, Mrs. James Breckinridge 

2519 Guilford Ave Wilmington 

Lovelace, Mrs. Thomas Claude Henrietta 

Lovell, Mrs. William Figgatt 

1517 Biltmore Dr Charlotte 

Lovill, Mrs. Robert Jones, Box 647 Mt. Airy 

Lowery, Mrs. Charles D Lowell 

Lowery, Mrs. John Robert 

1620 Wiltshire Salisbury 

Lownes, Mrs. Milton Markley, Jr. 

Redwheel Farm Dudley 

Lubchenko, Mrs. Nicholas Eleazer Harrisburg 

Lucas, Mrs. Robert Theodore, Jr. 

944 Henley Place Charlotte 

Lumb, Mrs. George Dennett 

1325 Hawthorne Road Wilmington 

Lund, Mrs. Herbert Zachareus 

3610 Kirby Dr Greensboro 

Lunsford, Mrs. Lewis, Jr. 

20 Hy-Vu Drive Asheville 

Lupton, Mrs. Carroll Crescent 

3300 Starmount Dr Greensboro 

Lupton, Mrs. Emmett Stevenson Alamance 

Lusk, Mrs. John A., Ill 

1800 W. Market St Greensboro 

Lusk, Mrs. Walter Coles, 946 Hill St., Greensboro 
Lutterloh, Mrs. Isaac Hayden, Sr. 

202 Mclver St Sanford 

Lutterloh, Mrs. Isaac Hayden, Jr. 

510 Walnut Dr Sanford 

Lutz, Mrs. James Dwight 

1125 Highland Ave Hendersonville 

Lyday, Mrs. Charles Emmett 

819 S. York St Gastonia 

Lyday, Mrs. Russell Osborne 

1610 Nottingham Rd Greensboro 

Lvmberis, Mrs. Marvin Nicholas 

2111 Radcliffe Ave Charlotte 



Lynch, Mrs. John Franklin, Jr. 

905 Arbordale Dr High Point 

Lynn, Mrs. Cy Kellie, Bouchard St. Valdese 

Lynn, Mrs. James Wiley, Jr. 

Rock wood Acres Burlington 

Lynn, Mrs. William S., Bristol Road Durham 

Lyon, Mrs. Brockton Reynolds 

Country Club Apts ..Greensboro 

McAdams, Mrs. Charles Rupert, Sr. 

31 W. Woodrow Ave Belmont 

McAdams, Mrs. Charles Rupert, Jr. 

Route 4, Sardis Rd Matthews 

McAllister, Mrs. Hugh Alexander 

Riverside Dr Lumberton 

McArn, Mrs. Hugh Munroe, 

701 Anson Ave Laurinburg 

McBryde, Mrs. Angus Murdoch 

411 E. Forest Hills Blvd Durham 

McCain, Mrs. John Lewis, 1601 Highland, Wilson 

McCall, Mrs. Michael Alvin Marion 

McCall, Mrs. William, Jr. 

508 Walter Court Winston-Salem 

McCarthy, Mrs. John Joseph 

N. C. Sanatorium McCain 

McCarty, Mrs. Ralph Leeves 

843 Hempstead PI Charlotte 

McClees, Mrs. Edward Count Elm City 

McClelland, Mrs. Joseph O Maxton 

McConnell, Mrs. Harvey Russell 

1119 Cumberland Ave Gastonia 

McCoy, Mrs. Joseph Bennett, Jr. 

2026 Sharon Lane Charlotte 

McCracken, Mrs. Joseph Pickett 

126 Pinecrest Rd Durham 

McCracken, Mrs. Marvin Howell 

28 Griffing Blvd Asheville 

McCutchan, Mrs. Frank 

Wilshire Dr., Milford Hills Salisbury 

McDonald, Mrs. Con T. 

1106 S. Madison Ave Goldsboro 

McDowell, Mrs. Harold Clyde 

200 Arbor Rd Winston-Salem 

McDowell, Mrs. Roy Hendrix 

20 Myrtle St Belmont 

McEaehern, Mrs. Duncan Roland 

1915 Hydrangea PI Wilmington 

McElrath, Mrs. Percy John 

2736 Toxey Dr Raleigh 

McElwee, Mrs. Ross S., Jr. 

2817 Belvedere Ave Charlotte 

McFadyen, Mrs. Oscar Lee, Jr. 

524 Valley Rd Fayetteville 

McGavran, Mrs. Edward G. 

Greenwood Rd Chapel Hill 

McGee, Mrs. Julian Murrill 

811 N. Elm St Greensboro 

McGill, Mrs. John Charles 

506 Crescent Hill Kings Mountain 

McGill, Mrs. Kenneth Harwood 

505 Crescent Hill Kings Mountain 

McGimsey, Mrs. James Franks, Jr. 

Edgewood St Morganton 

McGowan, Mrs. Claudius Plymouth 

McGowan, Mrs. Joseph Francis 

303 Vanderbilt Rd Asheville 

McGrath, Mrs. Frank Bernard 

212 E. 17th St Lumberton 

McGuffin, Mrs. William Christian 

52 Forest Rd Asheville 

Mcintosh, Mrs. Henry Deane 

2406 N. Duke St Durham 

McKee, Mrs. John Sasser, Jr. 

State Hospital Morganton 

McKee, Mrs. Lewis Middleton 

3633 Hope Valley Ed Durham 

McKenzie, Mrs. Edward Burt 

329 Summit Ave Salisbury 



September, 1960 



ROSTER OF MEMBERS 



429 



McKenzie, Mrs. Wayland Nash 
N. Tenth St 



..Albemarle 



McKinnon, Mrs. George Edward 
1836 Harris Road 



.Charlotte 



McKinnon, Mrs. William James 

501 W. Wade St Wadesboro 

McLain, Mrs. Bill Reid, Box 328 Troutman 

McLain, Mrs. John Edward G. 

3916 Rugby Rd Durham 

McLaurin, Mrs. Daniel Archie, Box 487 ....Dobson 
McLean, Mrs. Ewen Kenneth 

1110 Queens Rd., W Charlotte 

McLean, Mrs. James Wilton 

217 DeVane St Fayetteville 

McLendon, Mrs. Walter Jones, Box 116, Oakboro 
McLeod, Mrs. John Calvin, Jr. 

707 Pou St Goldsboro 

McLeod, Mrs. John Purl Uttley Marshviile 

McLeod, Mrs. William Leslie 

1504 Biltmore Dr ; Charlotte 

McLeod, Mrs. William Louis, S. Main St., Norwood 
McManus, Mrs. Hugh Forrest, Jr. 

3331 White Oak Rd Raleigh 

McMillan, Mrs. James Fulford 

907 Live Oak Pkwy Wilmington 

McMillan, Mrs. Robert Lindsay 

718 Arbor Rd Winston-Salem 

McMillan, Mrs. Robert Monroe 

Massachusetts Ave. Ext Southern Pines 

McMillan, Mrs. Roscoe Drake 

414 S. Main St Red Springs 

McMillan, Mrs. Thomas Henry, Jr. 

1412 Scott Court Charlotte 

McMurry. Mrs. Avery Willis 

106 Hillside Dr Shelby 

McNeill, Mrs. Claude Ackle, Jr. 

121 Church St Elkin 

McNeill, Mrs. James Hubert 

Pilson St North Wilkesboro 

McNiel, Mrs. Thomas Lee 

N. Brook St Wilkesboro 

McPheeters, Mrs. Samuel Brown 

307 Linwood Ave Goldsboro 

McPherson, Mrs. Charles Wade 

422 Fountain PI. ..._ Burlington 

McPherson, Mrs. Harry Thurman 

3200 Oxford Dr _ Durham 

McPherson, Mrs. Samuel Dace, Jr. 

29 Oak Dr _ Durham 

McRae, Mrs. James Thomas Elkin 

McRae, Mrs. Marvin Everett 

121 Beverly PI _ Greensboro 

McRee, Mrs. Jean Douglas 

808 Runnymeade Rd Raleigh 

McWhorter, Mrs. Robert Ligon 

905 Martin Dr Concord 

Mabe, Mrs. Paul Alexander 

122 Penrose Dr Reidsville 

MacAlpine, Mrs. Orville Duncan, Route 2, Chandler 
Macatee, Mrs. George, Jr. 

25 Inglewood Rd Asheville 

MacDonald, Mrs. J. Kingsley 

3600 Barclay Downs Dr Charlotte 

MacKay, Mrs. James Calvin 

1805 Grace St Wilmington 

Mackie, Mrs. George Carlyle, Box 927, Wake Forest 

MacLauchlin, Mrs. William Thompson Conover 

Macon, Mrs. Gideon Hunt Warrenton 

MacRae, Mrs. John Donald 

2813 Skye Dr Fayetteville 

Maddrey, Mrs. Milner Crocker 

610 Franklin St Roanoke Rapids 

Maher, Mrs. James A. 

Route 5, Box 249 Goldsboro 

Major, Mrs. Richard Smart 

816 Fourth Ave., W Hendersonville 

Maloney, Mrs. George R., Route 6 Fayetteville 



Maness, Mrs. Archibald Kelly 

1918 Granville Rd Greensboro 

Maness, Mrs. Paul Franklin 

1010 Central Ave Burlington 

Mangum, Mrs. Carlyle Thomas, Jr. 

Highland Drive Leaksville 

Manly, Mrs. Isaac Vaughan 

2215 Lakeview Dr Raleigh 

Manly, Mrs. James Hollowell, Jr. 

2100 St. James Rd Raleigh 

Manning, Mrs. Isaac Hall, Jr. 

3901 Hope Valley Rd Durham 

Marder, Mrs. Gerard 

Armstrong Park Rd Gastonia 

Marks, Mrs. Edgar Seymour 

1112 Hamel Rd. Greensboro 

Marr, Mrs. James Tilden 

1718 Virginia Rd Winston-Salem 

Marsh, Mrs. Frank Baker 

725 Lake Drive Salisbury 

Marshall, Mrs. Jamej Flournoy 

341 Arbor Rd Winston-Salem 

Marshburn, Mrs. Elisha Thomas, Jr. 

218 Brightwood Rd ...Wilmington 

Martin, Mrs. Benjamin Franklin 

2560 Warwick Rd Winston-Salem 

Martin, Mrs. Dan Anderson 

Sourwood Drive Chapel Hill 

Martin, Mrs. James Alfred 

1305 Walnut St Lumberton 

Martin, Mrs. James Franklin 

734 Roslyn Rd Winston-Salem 

Martin, Mrs. Moir Saunders 

314 Cherry St Mt. Airy 

Martin, Mrs. Sidney Arnold 

2711 Fairview Rd Raleigh 

Martin, Mrs. William Francis 

1534 Queens Rd., W Charlotte 

Mason, Mrs. Lockert Bemiss 

824 Country Club Rd Wilmington 

Mason, Mrs. Manly Newport 

Mason, Mrs. Philip, 808 Henkel Rd. Statesville 

Massey, Mrs. Charles Caswell 

1318 Carlton Ave Charlotte 

Matheson, Mrs. Robert Arthur 

Drawer 608 Raeford 

Matthews, Mrs. Hugh Archie Canton 

Matthews, Mrs. James H. 

8 Mt. Vernon Circle Asheville 

Matthews, Mrs. Roland Dellwood 

147 Tarleton Ave Burlington 

Matthews, Mrs. Vann M. 

3010 Central Ave Charlotte 

Matthews, Mrs. William Camp 

645 Hempstead PI Charlotte 

Matthews, Mrs. William Walter 

Oakland Heights Leaksville 

Maulden, Mrs. Paul Ranzo 

204 William St Kannapolis 

Mauzy, Mrs. Charles Hampton, Jr. 

1820 Greenbriar Rd. Winston-Salem 

Maxwell, Mrs. Clarence Schuyler Beaufort- 
May, Mrs. Harvey Craig 

1136 Berkeley Ave Charlotte 

May, Mrs. William Joseph 

1824 Georgia Ave Winston-Salem 

Mayer, Mrs. Walter Brem 

2828 St. Andrews Lane Charlotte 

Maynard, Mrs. Eugene Vincent 

P. O. Box 155 Elm City 

Meadows, Mrs. Joseph Herman 

108 Clyde Ave Wilson 

Means, Mrs. Robert Lee 

122 Revere Rd Winston-Salem 

Mease, Mrs. Willis Eugene Richlands 

Mebane, Mrs. Giles Yancey, Carr Street ....Mebane 
Mebane, Mrs. John Gilmer 

Tryon Rd Rutherfordton 



430 



NORTH CAROLINA MEDICAL JOURNAL 



September, 1960 



Mebane, Mrs. William Carter, Jr. 

4507 Wrightsville Ave Wilmington 

Medlin, Mrs. Joseph Robert, Jr. Rural Hall 

Mees, Mrs. Theodore Howell 

Maxton Rd Lumberton 

Melero, Mrs. Andres Tarcisio 

Newell Heights Roxboro 

Melton, Mrs. Robert Allen 

Route 3, Box 192, Pirate's Cove Wilmington 

Menefee, Mrs. Elijah Eugene, Jr. 

2203 Cranford Rd Durham 

Menzies, Mrs. Henry Harding 

814 Oaklawn Ave Winston-Salem 

Merritt, Mrs. Jesse Frederic 

1615 S. College Park Dr Greensboro 

Merritt, Mrs. John Hamlett 

Barnette Ave Roxboro 

Meschan, Mrs. Isadore 

751 Roslyn Rd Winston-Salem 

Metcalf, Mrs. Lawrence Edward 

Chunns Cove Rd Asheville 

Mewborn, Mrs. John Moses Farmville 

Miller, Mrs. Andrew C, III 

110 W. Mauney Circle Gastonia 

Miller, Mrs. Cameron Eugene Jefferson 

Miller, Mrs. Emery Clyde, Jr. 

438 Lynn Ave Winston-Salem 

Miller, Mrs. George Rolfe 

1040 Paramount Circle Gastonia 

Miller, Mrs. Harry, 108 Facility Dr., Fayetteville 
Miller, Mrs. Henry Rankin 

Fairway Drive Black Mountain 

Miller, Mrs. Ira Ben 

1007 Westwood High Point 

Miller, Mrs. Joseph Teles 

914 Springdale Lane Gastonia 

Miller, Mrs. Lloyd Davis Marion 

Miller, Mrs. Oscar Lee 

314 Fenton Place Charlotte 

Miller, Mrs. Robert Carlysle 

414 Harvie St Gastonia 

Miller, Mrs. Robert Evans 

1101 Boiling Rd Charlotte 

Miller, Mrs. Walton Hoy, Jr. 

1606 E. Mulberry St Goldsboro 

Miller, Mrs. Wan-en Edwin 

502 Pinkney St Whiteville 

Milhken, Mrs. James Shepard 

, B?x 55 Southern Pines 

Milling, Mrs. James Reaves Waynesville 

Millman, Mrs. Theodore Harris 

l? 5 Glovinia St Leaksville 

Mills, Mrs. Hugh Harrison 

McCall Ra Forest Citv 

Mills, Mrs. Wardell Hardee " ' 

1202 Country Club Dr Greensboro 

Minges, Mrs. Ray Donald 

Longmeadow Rd Greenville 

Minick, Mrs. James Elder, E. Main St., Booneville 
Mitchell, Mrs. George William 

807 W. Kenan St Wilson 

Mitchell, Mrs. Landis Patterson 

Huntley St Spindale 

Mitchell, Mrs. Rov Colonel Mt Airy 

Mitchener, Mrs. Calvin Chambers 

4865 Stafford CI Charlotte 

Mitchener, Mrs. James Samuel, Jr. 

Westwood Laurinburg 

Mock, Mrs. Charles Glenn 

l 1 , 7 Greylyn Dr Charlotte 

Mock, Mrs. Frank Lowe, Route 3 ... Lexington 

Mohr, Mrs. Jack Elmer, 207 E. 17th Lumberton 

Monroe, Mrs. Clement Rosenburg 

Thayer Cottage Pinehurst 

Monroe, Mrs. Daniel Geddie 

204 Churchill Dr ..Fayetteville 

Monroe, Mrs. Edwin Wall 

215 Library St Greenville 



Monroe, Mrs. John Howard 

2642 Philip St Winston-Salem 

Monroe, Mrs. Lance Truman 

218 N. Union St Concord 

Montgomery, Mrs. John Christian, Jr. 

2017 Radcliffe Ave. Charlotte 

Montgomery, Mrs. John Christian, Sr. 

1532 Queens Rd Charlotte 

Montgomery, Mrs. Wayne Swope 

55 Sunset Parkway Asheville 

Montgomery, Mrs. William Gardner 

Box 990 urianits Quarry 

Moon, Mrs. Richard Young 

49 Plymouth Circle ...Asheville 

Moore, Mrs. Burmah Dixon 

McAdenville Road Mount Hollv 

Moore, Mrs. D. Forrest, Box 136 Shelby 

Moore, Mrs. Davis Lee 

503 E. 5th St Greenville 

Moore, Mrs. Edward Eugene 

32 Fail-way Rd Asheville 

Moore, Mrs. Horace Greeley, Jr. 

2905 Harvard Dr Wilmington 

Moore, Mrs. James LeGrant 

2513 Colton Place Ralegh 

Moore, Mrs. John Andrew 

1513 Independence Rd Greensboro 

Moore, Mrs. Julian Alison 

34 Hilltop Rd Asheville 

Moore, Mrs. Laurie Walker Beaufort 

Moore, Mrs. Ralph Bryan 

1339 Hawthorne Rd Wilmington 

Moore, Mrs. Robert Alexander 

2415 Warwick Rd Win ;ton-Salem 

Moore, Mrs. Robert Alexander, Jr. 

605 Jennings Drive Wilmington 

Moore, Mrs. Robert Ashe 

1734 Queens Rd., W Charlotte 

Moore, Mrs. Robert Love 

311 W. Washington St Bessemer City 

Moore, Mrs. Roy Hardin Canton 

Moore, Mrs. William Locke 

616 Myers Lane Greensboro 

Moorefield, Mrs. Robert Hoyle 

203 East E St Kannapolis 

Mordecai, Mrs. Alfred 

806 S. Hawthrone Rd Winston-Salem 

Morehead, Mrs. Robert Page 

1051 Arbor Rd Winston-Salem 

Morey, Mrs. Milton B Morehead City 

Morgan, Mrs. Arthur Elwooc! 

2853 Skye Dr Fayetteville 

Morgan, Mrs. Benjamin Edward 

1205 Alta Vista Lane Rocky Mount 

Morgan, Mrs. Burnice Earl 

2 Cedarcliff Rd Asheville 

Morgan, Mrs. Charles Hermann 

1408 S. York St Gastonia 

Morgan, Mrs. Grady Alexander 

1 Cambridge Rd Asheville 

Moricle, Mrs. Charles Hunter 

1302 South Park Dr Reidsville 

Morris, Mrs. Donald Shonk 

2398 Warwick Rd Winston-Salem 

Morris, Mrs. James Francis 

803 S. Madison Ave Goldsboro 

Morris, Mrs. John Watson Morehead City 

Morris, Mrs. Leslie Morgan 

1122 S. Edgemont Ave Gastonia 

Morris, Mrs. Marshal Glenn, Jr. 

3700 Starmount Dr Greensboro 

Morris, Mrs. Rae Henderson 

67 Louise Ave Concord 

Morrison, Mrs. Frank Waynesville 

Morrison, Mrs. Robert Holcombe 

331 Fairfield Rd Fayetteville 

Morrison, Mrs. Roger William 

65 Sunset Parkway Asheville 



September, 1960 



ROSTER OF MEMBERS 



431 



Morton, Mrs. Levi Thomas 

2601 Cloister Dr Lincolnton 

Moseley, Mrs. Charles Herbert Clyde 

Moss, Mrs. George Oren 

Cleghom Rd Rutherfordton 

Moss, Mrs. Paul Hudson 

Muirhead, Mrs. Samuel John 

Veterans Hospital Salisbury 

Mullen, Mrs. Malcolm Preston 

1813 W. Nash St Wilson 

Murchison, Mrs. David Reid 

315 S. Third St Wilmington 

Murphy, Mrs. Gibbons Westbrook 

22 Hampstead Rd Asheville 

Murphy, Mrs. Thomas Lynch 

409 Mocksville Ave Salisbury 

Myers, Mrs. Alonzo Harrison 

414 Fenton PI Charlotte 

Myers, Mrs. Richard Thomas 

600 Kingsbury Circle Winston-Salem 

Nailling, Mrs. Richard Cabot 

85 St. Dunstans Rd. Asheville 

Nalle, Mrs. Brodie C, Sr. 

906 S. College St Charlotte 

Nance, Mrs. Charles Lee 

1825 E. 7th St Charlotte 

Nance, Mrs. Frederick Lee, Jr. 

Route 3, Box 130M Kannapolis 

Nance, James Edwin 

P. O. Box 367 Kannapolis 

Nance, Mrs. John Wesley 

410 Powell St Clinton 

Nanzetta, Mrs. Leonard Anes 

2756 Windsor Rd Winston-Salem 

Nash, Mrs. Thomas Palmer, III 

306 E. Colonial Elizabeth City 

Naumoff, Mrs. Phillip, 2320 Croydon Rd., ..Charlotte 

Neal, Mrs. John William, Main Street Gibson 

Neal, Mrs. Joseph Walter 

1344 Brooks Ave. Raleigh 

Neal, Mrs. Rutherford Douglas 

2532 Hampton Ave Charlotte 

Neeland, Mrs. Eugene Crawford 

1506 Grove St Wilson 

Neese, Mrs. Kenneth Earl 

611 Lancaster Ave Monroe 

Nelson, Mrs. Charlotte 

2205 Woodview Rd Kinston 

Nelson, Mrs. Sully Ayden 

Nelson, Mrs. William Howell, Box 328 Clinton 

Netsky, Mrs. Martin George 

1030 Deepwood Court Winston-Salem 

Neville, Mrs. Cecil Howell Scotland Neck 

Newell, Mrs. Ernest T., 314 Cooper St Dobson 

Newman, Mrs. Glenn Carraway 

Coharie Dr Clinton 

Newman, Mrs. Harold Hastings, Jr. 

11 Oak Rd _ Salisbury 

Newsome, Mrs. Henry Clay 

Box 385 Pilot Mountain 

Newton, Mrs. Howard Lowell 

244 Hempstead PI Charlotte 

Newton, Mrs. William King 

Finley Park North Wilkesboro 

Niblock, Mrs. Franklin Chalmers, Jr. 

136 S. Union St Concord 

Nichols, Mrs. Austin Flint, Box 498 Roxboro 

Nichols, Mrs. Rhodes Edmond, Jr. 

1626 University Dr Durham 

Nichols, Mrs. Thomas Rogers 

306 W. Union St Morganton 

Nicholson, Mrs. Henry Hale, Jr. 

1822 Lynwood Rd Charlotte 

Nicholson, Mrs. William McNeal 

824 Anderson St Durham 

Nifong, Mrs. Frank Miller Clemmons 

Noble, Mrs. Baxter G., 604 Rudolph Goldsboro 



Noel, Mrs. George Thompson 

407 Knollwood Dr Kannapolis 

Nolan, Mrs. James Onslow 

300 Cannon Blvd. Kannapolis 

Norfleet, Mrs. Charles Millner, Jr. 

2566 Warwick Rd Winston-Salem 

Norment, Mrs. William Blount 

702 Woodland Dr Greensboro 

Norris, Mrs. Louis Jerome, Jr Morehead City 

North, Mrs. Ellsworth Howard, Jr. 

Riverview Crescent Elizabeth City 

Norton, Mrs. Howard Binning 

Route 1, Mills River Valley Horse Shoe 

Norton, Mrs. John W. Roy 

2129 Cowper Dr Raleigh 

Nowlan, Mrs. Fagg Bernard Pleasant Garden 

Nowlin, Mrs. George Preston 

946 Bromley Rd Charlotte 

Nunnery, Mrs. William Ernest 

632 S. Main _ Rutherfordton 

O'Briant, Mrs. Albert Lee, P. O. Box 245, Raeford 
O'Brien, Mrs. Paul Stevens 

1429 E. Chaloner Dr Roanoke Rapids 

Odom, Mrs. Guy Leary 

2812 Chelsea CI., Hope Valley Durham 

Odom, Mrs. Robert Edwin 

99 Evelyn Place Asheville 

Odom, Mrs. Robert Taft 

1809 Virginia Rd Winston-Salem 

Oehlbeck, Mrs. Luther William F., Jr 

214 Poplar St Lenoir 

Oehlbeck, Mrs. Luther William F., Sr. 

618 Third Ave., N. W Hickory 

Oelrich, Mrs. August M. 

613 Palmer Dr Sanford 

Offutt, Mrs. Vernon Delmus 

910 Rountree St Kinston 

Ogburn, Mrs. Herbert Hammond 

1806 W. Market Greensboro 

Ogburn, Mrs. Leon N. 

1623 Canterbury Rd Raleigh 

Ogburn, Mrs. Lundie Calvin 

945 Kenleigh CI Winston-Salem 

Oleen, Mrs. George Gerhard, Medlin Rd Monroe 

Olive, Mrs. Percy Wingate 

1322 Woodland Dr Fayetteville 

Oliver, Mrs. Jim Upton 

2624 Fairview Rd Raleigh 

Oliver, Mrs. Joseph Andrew, Box 458 ....Rockwell 

Olson, Mrs. Robert M., P. O. Box 126 Kenly 

O'Quinn, Mrs. Edward Nelson 

1810 Princess St Wilmington 

Ormand, Mrs. John William 

309 Lancaster Ave Monroe 

Ormond, Mrs. Allison Lee 

108 Sixth Ave., N. W Hickory 

Outlaw, Mrs. Jackson Kent 

808 Pee Dee Ave Albemarle 

Owen, Mrs. Duncan Shaw 

201 Oakridge Ave Fayetteville 

Owen, Mrs. George Franklin, Jr. 

120 W. Lynch St Durham 

Owen, Mrs. John Fletcher 

2631 Fairview Rd Raleigh 

Owen, Mrs. William Boyd Waynesville 

Owens, Mrs. Francis Leroy Pinehurst 

Owens, Mrs. Zack Doxey, Taylor's Beach, Camden 
Owsley, Mrs. Lawrence Hayes 

Beverly Heights Boone 

Pace, Mrs. Charles T., 936 Hill St Greensboro 

Pace, Mrs. Karl Busbee, 404 Summit St., Greenville 
Pace, Mrs. Samuel Eugene 

1617 Market St Wilmington 

Packard, Mrs. Douglas Richards 

P. O. Box 22 Clinton 

Padgett, Mrs. Charles King 

Cleveland Springs _ Shelby 



432 



NORTH CAROLINA MEDICAL JOURNAL 



September, I960 



Padgett, Mrs. Philip Grover 

605 N. Piedmont Ave Kings Mountain 

Page, Mrs. Ernest Benjamin, Jr. 

2207 Wheeler Rd Raleigh 

Page, Mrs. George Dantzler 

1855 Cassamia PI Charlotte 

Page, Mrs. Harvey A., Kent St Durham 

Painter, Mrs. William Watson 

920 N. Main St. Mooresville 

Palmer, Mrs. Yates Shuford, Louise Rd Vaidese 

Palmes, Mrs. Wesley Calhoun, Jr. 

440 Ridgeway Ave Statesville 

Parham, Mrs. Asa Richmond 

1045 Rockford Rd High Point 

Parker, Mrs. Charles Council, 114 Warren ..Wilson 

Parker, Mrs. John Wesley, Jr. Seaboard 

Parker, Mrs. Oscar Lee, 706 College St. .Clinton 
Parker, Mrs. Roy Turnage 

111 Pinecrest Rd Durham 

Parker, Mrs. Samuel Lester, Jr. 

1202 Harding Ave Kinston 

Parker, Mrs. Shepherd Falkener 

Cleveland Springs Shelby 

Parker, Mrs. Talbot Fort, Jr. 

603 Prince Ave Goldsboro 

Parkinson, Mrs. Thomas William 

417 Thomas Trail Gastonia 

Parks, Mrs. William Craig 

Emerywood Estates High Point 

Parris, Mrs. Alva E. 

1317 Drumcliff Rd Winston-Salem 

Parrott, Mrs. Frank Strong 

322 Mocksville Ave Salisbury 

Parrott, Mrs. John Arendall 

2206 Woodview Rd. Kinston 

Parsons, Mrs. Lacy Jack, Jr. 

2404 Rowland Ave Lumberton 

Parsons, Mrs. William Herbert Ellerbe 

Paschal, Mrs. George Washington, Jr. 

3334 Alamance Dr Raleigh 

Paschold, Mrs. John Henry, Park Lane, Albemarle 
Pate, Mrs. Archibald Hanes 

110 S. Oleander Ave Goldsboro 

Pate, Mrs. James Frank, Sr Canton 

Pate, Mrs. James Lloyd Fairmont 

Pate, Mrs. William Henry Pikeville 

Patrick, Mrs. Simmons Isler 

2202 Greenbriar Rd Kinston 

Patterson, Mrs. Carl Norris 

3930 Plymouth Rd., Hope Valley Durham 

Patterson, Mrs. F. M. Simmons 

1507 Tryon Rd. New Bern 

Patterson, Mrs. Fred Geer 

511 Senlac Rd Chapel Hill 

Patterson, Mrs. Hubert Clifton 

Pittsboro Rd. Chapel Hill 

Patterson, Mrs. Joseph Flanner, Jr. 

Trent Shores New Bern 

Patterson, Mrs. Joseph Halford Broadway 

Patton, Mrs. John Donald 

56 Elk Mtn. Scenic Hwy Asheville 

Patton, Mrs. William Hugh, Jr. 

Terrace PI Morganton 

Payne, Mrs. Clifton G. 

1203 Morgan Drive Reidsville 

Peak, Mrs. Latham Conrad 

409 Lafayette St Clinton 

Pearse, Mrs. Richard Lehmer 

713 Anderson St Durham 

Pearson, Mrs. Hugh Oliver, Box 26 Pinetops 

Pearson, Mrs. John Kent, Pearson St Apex 

Peck, Mrs. Harold Artemus 

425 Dogwood Lane .Southern Pines 

Peele, Mrs. James Clarendon 

120S Perry Park Dr Kinston 

Peeler, Mrs. Forrest Edwards Maiden 

Peete, Mrs. Charles Henrv 

2027 Woodrow St Durham 



Pender, Mrs. John Robert, III 

701 Ashworth Rd Charlotte 

Penick, Mrs. George Dial 

Whitehead Circle Chapel Hill 

Pennington, Mrs. Glenn Walton 

220 Queens Road East Charlotte 

Pennington, Mrs. Luther Thomas 

218 Homewood Dr Greensboro 

Perreten, Mrs. Frank Arnold 

1620 Thorneliffe Rd Winston-Salem 

Pen-in, Mrs. Thomas Samuel, Jr. 

1761 Sterling Rd Charlotte 

Perritt, Mrs. John Olin 

1327 Hawthorne Rd Wilmington 

Perry, Mrs. David Russell 

1120 Eighth St Durham 

Perry, Mrs. David Russell, Jr. 

746 Sylvan Rd Winston-Salem 

Perry, Mrs. Glenn Grey 

702 Sunset Dr High Point 

Perry, Mrs. Henry Baker, Jr. 

208 Homewood Dr Greensboro 

Perry, Mrs. Solomon Paul 

3602 Rugby Rd., Hope Valley Durham 

Perryman, Mrs. Olin Charles, Jr. 

3312 Anderson Dr Winston-Salem 

Persons, Mrs. Elbert Lapsley 

732 Anderson St '. Durham 

Peters, Mrs. August Richard, Jr. 

Washington Park Washington 

Pettus, Mrs. William Henry, Jr. 

2051 Cassamia PI Charlotte 

Pfeiffer, Mrs. John B., Jr., Rugby Rd Durham 

Phelps, Mrs. James Solomon, Jr. 

4936 Tewkesbury Rd., Allen Hills Charlotte 

Phifer, Mrs. William Houston 

Lancaster Rd Monroe 

Phillips, Mrs. Charles A. Speas 

525 E. Massachusetts Ave Southern Pines 

Phillips, Mrs. Charles Kenneth, Box 8, Skyland 

Phillips, Mrs. Ernest Nicholas 

Finley Park North Wilkesboro 

Phillips, Mrs. William Allen 

Greenville Sound Wilmington 

Pickard, Mrs. Henry Mack 

5002 Oleander Dr Wilmington 

Pickrell, Mrs. Kenneth L., 3 Sylvan Rd., Durham 
Pierce, Mrs. Edwin 

824 Chamberlain St Raleigh 

Pigford, Mrs. Robert Toms 

155 Colonial Dr Wilmington 

Pishko, Mrs. Michael Thomas 

Midland Rd Pinehurst 

Pittman, Mrs. Alfred Roland, Jr. 

2304 Rowland Ave Lumberton 

Pittman, Mrs. Dorn Carl 

Alamance Acres Burlington 

Pittman, Mrs. Malory Alfred 

Raleigh Rd Wilson 

Pittman, Mrs. Raymond Lupton, Sr. 

645 Hay St Fayetteville 

Pittman, Mrs. William Austin 

118 Stedman Ave Fayetteville 

Pitts, Mrs. William Reid 

429 Eastover Rd Charlotte 

Piver, Mrs. James DeCamp 

202 E. Bayshore Blvd Jacksonville 

Piver, Mrs. William Crawford, Jr. 

Washington Park Washington 

Pixley, Mrs. Roland Theo 

2018 Bucknell Charlotte 

Plonk, Mrs. George Webb 

Crescent Hill Kings Mountain 

Plyler, Mrs. Ralph Johnson 

611 Mocksville Ave Salisbury 

Podger, Mrs. Kenneth Arthur 

217 E. Markham Ave Durham 

Pollock, Mrs. Raymond, 509 Middle St., New Bern 



September, 1960 



ROSTER OF MEMBERS 



433 



Pool, Mrs. Bennett Baucom 

2301 Buena Vista Rd Winston-Salem 

Poole, Mrs. Marvin Bailey 

500 S. Layton Ave Dunn 

Poole, Mrs. Robert Franklin, Jr. 

1631 St. Mary's St Raleigh 

Pope, Mrs. Henry T. 

304 E. 17th St Lumberton 

Pope, Mrs. Robert Clyde 

404 Monticello Dr ...Wilson 

Porter, Mrs. Richard Allison 

Haywood Forest Hendersonville 

Poteat, Mrs. Hubert McNeill, Jr. 

422 Church St Smithfleld 

Pott, Mrs. Walter Hawks 

102 Lakewood Dr Greenville 

Powell, Mrs. Albert Henry 

1632 University Dr Durham 

Powell, Mrs. Eppie Charles, Jr. 

804 E. Park Ave Goldsboro 

Powell, Mrs. Jack, 1951 Haywood Rd., Asheville 
Powell, Mrs. William Flynn 

62 Gertrude PI Asheville 

Powers, Mrs. Frank Poydras 

2529 White Oak Rd Raleigh 

Powers, Mrs. John Alfred 

2035 Sherwood Rd Charlotte 

Prather, Mrs. Fonzo Goff 

131 Cambridge Rd Asheville 

Prefontaine, Mrs. Joseph Edouard 

901 Dover Rd Greensboro 

Presley, Mrs. George Donald Canton 

Pressly, Mrs. Claude Lowry 

1863 Cassamia PI Charlotte 

Pressly, Mrs. David Lowry 

576 Dogwood Rd Statesville 

Preston, Mrs. John Zennas, Hickorywood, Tryon 
Prevatte, Mrs. John Edgar 

514 S. First St Smithfield 

Prince, Mrs. George Edward 

807 Townsend Ave Gastonia 

Printz, Mrs. Don Ralph 

340 Midland Dr Asheville 

Pritchard, Mrs. George Littleton 

119 Church St Black Mountain 

Pritchett, Mrs. Newton George 

1705 St. Mary's St Raleigh 

Proctor, Mrs. James Thornton 

428 Ridgefield Rd Chapel Hill 

Proctor, Mrs. Richard Culpepper 

381 Westview Dr Winston-Salem 

Pruitt, Mrs. George Calhoun 

Lancaster Lane Rockingham 

Pugh, Mrs. Char